The Rotary Club of Audley
Donation Form
I wish to sponsor a light to shine on the
  "Rotary Tree of Light"
in memory of 

Name (or cause) to be remembered - (the above text will be published in Audley Library)
 Please also publish it on the Internet Book of Remembrance

and to Support Donna Louise Hospice (suggested minimum £3 per light)   
Number of Lights required      Total enclosed £ 
Name: (the information below will NOT be published anywhere)

Address :

Post Code :

Email Address : 

Signature (to confirm above details and acceptance of terms & conditions) _________________________________________          
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Credit Card Number :

Expiry:    

Amount Donated £'s Sterling :


(minimum £10 please by credit card)

 
Signature to authorise Credit Card payment ________________________________
 
Please complete the form above, then print & post to address below with
Postal orders/cheques payable to 'Audley Rotary Club'
  • Audley Rotary Tree of Light
    Mr I. Knight
    53 Stephens Way
    Bignall End
    STOKE-on-TRENT
    ST7 8PL
 
  • Alternatively the forms may be handed in at
  • St James Church Office,
    14 Church Street,
    Audley,                 ST7 8DE
 
Save Paper - Fold to fit the address in a used window envelope