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Name: (the information below will NOT be published anywhere)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
Park Farm, Park Lane
Audley
STOKE-on-TRENT
ST7 8HP
England                                    Return to Audley Tree of Light homepage
Save Paper - Fold to fit the address in a used window envelope