Personal Details

Details (*indicates a mandatory input)
*First Name
*Contact No
Mobile No
Date of Birth
*Email Address
*Confirm Email
Enter your postcode, then click ‘find address’ to automatically populate your address.
*Address Line 1
Why have you chosen to support us?
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As you have chosen to support us regularly we will record your contact details on our fundraising database and periodically let you know about the impact of your donation with updates on Hospice news. You can also let us know about your other interests by ticking the boxes below. If you do not tick any of the boxes we will not contact you about these additional areas. If you want to change how we communicate with you, please get in touch at or 01622 790195.

Fundraising Activities:
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Hospice News:
Anything else you think I'd be interested in:

Further information on how your personal data is used is available in our Privacy Policy at

Payment Details
Bank Details
Heart of Kent Hospice
Preston Hall
ME20 7PU


For any queries contact our Fundraising Team: 01622 790195

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.