Thank you for your support

Thank you for choosing to sign up to our lottery and supporting your local Hospice. Please provide your contact and payment information below to get started.

Personal Details

Details

*Title

*First name

*Surname

*Main phone number

Alternate number

*Date of birth

I confirm I am over 18

*Email address

*Confirm email

Address

Enter postcode and optionally house number in address line1 then click 'Find Address'

*Postcode

*Address line 1

*Town

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*How did you hear about us?

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*Reason for choosing to sign up to our lottery?

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Keep in Touch

We provide support and comfort to people suffering with a life limiting illness, enabling them to do the things they love with the time they have left. That’s why we would love to keep in touch and keep you informed of our latest news, future fundraising activities, appeals, lotteries and other ways in which you can support us. Please tell us how we can keep in touch with you by ticking the options below and filling in your details:

by email

by SMS

We will contact you by post or phone about how your support has made an impact for local families. However, here at ellenor we only want to contact you in way you decide to be contacted, if you would prefer not to hear from us please tick the box below:

I do not wish to hear about ellenor by post or phone

To ensure your donation goes to where it’s needed most would you like to receive all further communications regarding your lottery gift to be sent by email instead of post?

Our promise to you

We will keep your details safe and will only allow your information to be used by suppliers working on our behalf. We will not sell or give your contact details to any other organisation to use for their own purposes unless requested to by law. View our complete privacy policy: www.ellenor.org/privacy-policy

Payment Details

Bank Details

ellenor
Coldharbour Road
Northfleet
Gravesend
Kent
DA11 7HQ

Email: supportercare@ellenor.org

For any queries contact our helpline: 01322 626509

Are you the only signatory required to authorise this direct debit? If not, please contact us for a paper mandate which must be completed with all necessary signatures.