Memorial Tree Form Title Mr Miss Mrs Ms Dr Other Title Title Surname Address Line 1 Address Line 2 Town/City County Postcode Phone Email Full Name of the loved one: Relationship to the loved one: Select Leaf Colour: Green Acrylic Leaf (translucent) Gold Metal Lead (gloss finish) Mahogany Metal Leaf (matte finish) How long would you like the leaf on the tree: 1 Year: £120.00 for 1 year 3 Year: £300.00 for 3 years Lifetime: £1500.00 for Lifetime Dedication Line One: 12 Line Two 15 Line Three 23 Line Four 15 Line Five 11 Did your loved one use Lindsey Lodge Services? Yes No Are you interested in being filmed as part of our every leaf tells a story campaign? Yes No Claim Giftaid on my donation More about Giftaid → Marketing Tick the boxes below to sign up to receive our latest news & promotions from our marketing team. For more information on how we process your data, please see our privacy policy. Email SMS/Telephone Post By ticking, you are confirming that you have read, understood and accept the Terms & Conditions Add to Basket Terms & Conditions On receipt of your order form your request will be granted subject to approval of the inscription, availability of leaves and remaining space being available on the Memorial Tree. Lindsey Lodge Hospice & Healthcare reserves the right to refuse any application at its discretion. Lindsey Lodge Hospice & Healthcare retains complete control over the location and dates of installation of all leaves on the Memorial Tree. Leaves are Green Acrylic, Gold and Mahogany. Each leaf can only hold up to 76 characters including punctuation and spaces. The name engraved on your leaf will appear exactly as entered so please check spelling carefully. Payee must inform the Fundraising team of any changes to their contact details. If the payee is uncontactable at time of renewal, the leaf will be removed and stored safely at the Hospice. In exceptional circumstances Lindsey Lodge Hospice and Healthcare reserves the right to relocate the Memorial Tree. Lindsey Lodge Hospice and Healthcare are able to change the suggested donation of each leaf should they need to.
