Personal Details
*First name
*Contact no
Mobile no.
*Email address
*Confirm email
Enter postcode and optionally house number in address line1 then click 'Find Address'
*Address line 1
*Please choose your free gift as a thank you for sponsoring our nurses.
The personal information you have provided to Bolton Hospice will be processed in accordance with current UK data protection legislation and our privacy policy which is available to view at or upon request. The main purpose for which we process your personal information is to administer your sponsor a nurse donation but for further information please see our privacy policy. Your information will be held securely and we will never sell it to anyone else.

You can change your contact preferences at any time by calling us on 01204 663 055 or emailing We’d like to contact you with information about upcoming fundraising activities and how your support is helping. Please tell us if you are happy for us to do this (tick relevant boxes):
Payment Details
Bank Details
Bolton Hospice
Queens Park Street


For any queries contact our helpline: 01204 663 055

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

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