 The never ending call for Hospice care for the terminally ill requires an ever increasing income. We now have 28 full time staff and some 200 volunteers caring for in excess of 300 patients on a monthly basis. We are therefore appealing to members of our community to assist Hospice by joining our Hospice Donor Club which involves making monthly donations in multiples of R50 (per unit).
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Donor Club Application Form |
Application to join Hospice Donor Club.
(Please print)
Name:_______________________________________________________
Address:_____________________________________________________
(Postal)
_______________________Postal code________
Phone number:__________________ Cell:________________________
Email address:_______________________________________________
Number of R50 units required:_____ Lottery _____ or 100% Donation_____
Payment method: (please tick)
Stop Order ___ Cheque ___ Electronic transfer ___ Credit Card ___
Do you require a receipt for tax purposes? ______
Your bank details -
to be used for prize payment purposes only.
Bank:_____________________
Branch____________________
Branch number:___________ Account number :____________________
Please note that your name will only be entered for the quarterly draw once
your payment has been received.
For office use only - Hospice Donor Club No:- _____
Payment options.
1. STOP ORDER: Should you choose this method of payment you will need
a Donor Club reference number. This number must given to your bank when you
complete a stop order instruction. As banks will no longer accept stop orders
lodged by third parties you will have to attend to this aspect yourself.
When Hospice receive your
application form we will phone you and give you
a membership number.
2. ELECTRONIC TRANSFER: Our
bank details are given below:
Hospice Knysna
Nedbank
Knysna
Branch number 108-914
Account number 1089045948
3. CHEQUE: Send your cheque for the amount of tickets you wish to take and we
will send a reminder a month before your last ticket is drawn.
4. CREDIT CARD:
PLEASE RETURN TOGETHER WITH APPLICATION
Type of card:___________ Cardholders Name:__________________________
Card number _____________________________________ expires__________
3 digit check number _______
(on reverse of card)
Signature.____________________________ Date ____________________
First payment is to be made on 20th___________and monthly/annually thereafter.
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Purpose
To ensure that Knysna Sedgefield Hospice merits the respect and trust of the local community, and that donors and prospective donors can have full confidence in the organization, we declare that donors (local community, trusts, foundations and institutions with corporate social investment programmes) have these rights:
Scope
- To be informed of Hospice's mission, of the way the organization intends to use donated resources, and of its capacity to use donations effectively for their intended purposes.
- To be informed of the identity of those serving on Hospice's governing board, and to expect the board to exercise prudent judgement in its stewardship responsibilities.
- To have access to Hospice's most recent financial statements and other relevant information as requested.
- To be assured their gifts will be used for the purposes for which they were given.
- To receive appropriate acknowledgement and recognition.
- To be assured that information about their donation is handled with respect and with confidentiality.
- To expect that all relationships with individuals representing Hospice will be professional in nature.
- To be assured that those seeking donations are volunteers or employees of Hospice.
- To feel free to ask questions when making a donation and to receive prompt, truthful and forthright answers.
- To visit Hospice, announced or unannounced, and be shown the functioning of the Integrated Community-based Home Care programme.
Adapted with acknowledgement and thanks to:
- American Association of Fundraising Counsel (AAFRC),
- Association for Healthcare Philanthropy (AHP),
- Council for Advancement and Support of Education (CASE),
- Association of Fundraising Professionals (AFP).
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