Personal Details
Details
*Title
*First name
*Surname
*Contact no.
Mobile no.
*Date of birth
To comply with Gambling Commission regulations, you must tick this box to confirm
that you are 18 years of age or over to enter our lottery.
Sex?
Prefer not to say
Male
Female
*Email address
*Confirm email
Address
Enter postcode and optionally house number in address line1 then click 'Find Address'
*Postcode
*Address line 1
*Town
County
Where did you hear about us?
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Facebook
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Internet search
Leaflet about Rainbows
Rainbows newsletter
Newspaper article
Rainbows talk
Rainbows event
Rainbows website
Someone came to my house
Other (please specify)
Please specify:
Why are you supporting us?
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Because it's a local charity
Because it's a children's charity
Family or Relative is affected by a life limiting Illness
Friend or relative is cared for by Rainbows
Recommended by a friend
Other (please specify)
Please specify:
See the impact of your donation
We would like to keep you informed about our vital work and the many different ways you can help the children, young people and families that use Rainbows Hospice.
We will do that by writing to you, or telephoning you, for example to thank you for a donation. We will only be in touch when we think we have something you’d be interested in, such as news, appeals or ways you can support us. With your permission we’d also really like to contact you by email as its often easier and saves us money. If that’s Ok please tick the box
Please keep me informed by email
Payment Details
Bank Details
Rainbows
Lark Rise
Loughborough
Leicestershire
LE11 2HS
Email:
lottery@rainbows.co.uk
For any queries contact our Helpdesk No: 01509 638058
You will need your account details, which can be found on your cheque book or bank statement, to complete the direct debit instruction. 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.
Cope Children's Trust is licensed and regulated in Great Britain by the Gambling Commission under account number
8465
. You can find out more
here
.