Make a donation today to help us transform the playroom.

I'd like to make a donation towards transforming the children's playroom at St Mary's Hospital:

£100 £50 £25

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Gift Aid

Please contact me about my donation

For every £1 you donate, Gift Aid allows us to claim 25p from HM Revenue & Customs, increasing the value of your donation at no extra cost to you. Please tick the box below:

Yes, I would like Imperial Health Charity to claim Gift Aid on any donations I make in the future or have made in the past four years. I am a UK taxpayer and I understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

Signature Date

Yes, I would like to hear from Imperial Health Charity about the impact my gift has made as well as other news, events and opportunities to support their work. (You can opt out of communications at any time by emailing fundraising@imperialcharity.org.uk. For more information, go to imperialcharity.org.uk/privacy)

Please make sure all the fields above are completed and return this form to: Winter Appeal, Imperial Health Charity, 178-180 Edgware Road, London, W2 2DS

Should we exceed our target for this appeal, we'll make sure your gift goes towards other important projects for the benefit of children and families receiving care at St Mary's.

A registered charity, no. 1166084