Donation Form
Please print out and fill in. Once complete send, with your donation, to

The Finance Director
Good Hope Hospital NHS Trust
Rectory Road
Sutton Coldfield
B75 7RR

(Please Print in capitals)

I/We wish to engrave a leaf on the Tree of Good Hope

Name to appear on leaf ______________________________________________

Donor's name ______________________________________________________

Address __________________________________________________________

__________________________________________________________________

Postcode _____________________ Telephone Number ____________________

Signature ____________________________________Date _________________

Please treat as a Gift Aid donation Tick Here

Signature ____________________________________Date _________________

Cheque enclosed for £100 payable to Good Hope Hospital CharitableFunds A/C

Please charge my credit/debit card

Visa Mastercard Switch Other ______________________________

Name ____________________________________________________________

Signature ____________________________________Date _________________

Registered Charity 1058533