Personal Details
Sponsor A Nurse
Details
*Title
*First Name
*Surname
*Contact No
Mobile No
*Email Address
*Confirm Email
Address
Enter postcode and optionally house number in address line1 then click 'Find Address'
*Postcode
*Address Line 1
*Town
County
Is there a particular reason why you have chosen to support us?
Where did you hear about this?
-- Please Select --
Whilst on Prospect Hospice website
Prospect Newsletter
Received information in the post
At a Prospect Hospice event
Through my work
Picked up a Leaflet
Word of Mouth
Received a phone call from Prospect Hospice
Other
Please Specify:
How would you like to keep in touch?
We'd love to contact you from time to time with news and information about what we are doing and how you can get involved. Please select how we may contact you.
Email
Phone
You can change your contact preferences on our website at any time at
Prospect Hospice – How you hear from us
. To find out more about how we use your information visit
Prospect Hospice – Privacy Policy
.
Payment Details
Bank Details
Prospect Hospice Ltd.
Moormead Road
Wroughton
Swindon
Wiltshire
SN4 9BY
Email:
FundraisingandEvents@prospect-hospice.net
For any queries please contact us on: 01793 816161
To complete a direct debit you will need your account details, which can be found on your cheque book or bank statement.
Is the account in your name? Are you the only signatory required to authorise this direct debit? If not, please click
here
for a paper mandate (PDF format) which should be printed off and sent to us with all necessary signatures.