Gift Information

Donation Amount*
  • £35 to donate a a medium Memory Box and all its contents to a familiy who have lost their baby between 14-24 weeks gestation.
  • Other £

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

We'd love to keep in touch

We would like to keep you updated with our upcoming awareness events, fundraising campaigns, news and appeals, but in order to do this you must Opt-in via the consent fields below. 

If you choose to opt-in we will keep your details safe and will not pass them to any other organisations for their own marketing purposes. You can change your mind and opt out at any time too. For more information please read our privacy policy

 

Payment Information

Yes, reclaim Gift Aid on all my donations so that each £1 is worth an extra 25p to SIMBA. This declaration is valid for the current tax year (6 April to 5 April), the previous four tax years and all future years. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for year of a donation that is at least equal to the amount of tax that all the charities and Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for the current tax year. I understand that other taxes such as VAT and Council Tax do not qualify.
Amount*
£
Name on Card*
Card Number*
Additional Comments

Security Code

Share This Form

Powered by eTapestry.