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The information that you have provided on this form will be held on our fundraising database.

Unless you have instructed us otherwise, we will use the details you have provided to contact you about St Cuthbert's Hospice news and events.

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St Cuthbert’s Hospice
Park House Road
Durham
DH1 3QF
DDLogo

Email: hello@stcuthbertshospice.com

For any queries contact our helpline: 0191 374 61 66

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.