Hospice Information | Donor Club Application Form |
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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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Hospice Shoppe
Please encourage your friends to support the Knysna and Sedgefield shoppes.
How to get involved?
Volunteers can get involved withor should you wish to contribute financially there are 4 options:
Donor Club Winners
The recent Donor Club draw took place on 19th July, 2010 about 15t minutes after our third prize winner had paid their dues!! The second prize winner commented on his way out of the building - 'please phone me to tell me I have won a prize'. Witnessed by 3 Managerial staff and with a random number computer draw - such was the result. First prize was won by one of our first members who was delighted with his success! And so the results....First Prize - R5,800 Bill Mather
Second Prize - R2,400 Chris Bourlay
Third Prize - R1,500 Pat Godding
Congratulations to all the winners and best of luck to all in the next draw which will take place in October 2010.