£1 on the Bill Registration Form 1About Restaurant / Pub2Personal Details3About Your £1 on The Bill Fundraiser 4Marketing Options Restaurant or Pub Name(Required)Address(Required) Street Address Address Line 2 City County Postcode Organisational email address(Required) Organisation Telephone Number (please do not include spaces)(Required) Name(Required) First Last Job Title(Required)Work Email(Required) Daytime Contact Number(Required) What date are you planning to start adding your discretionary £1.00 on the bill?(Required) DD slash MM slash YYYY Please tell us why you're fundraisingMy family has been supported by Helen & Douglas HouseI know someone who has been supported by Helen & Douglas HouseI want to honour the memory of a loved one or friendI want to give back to othersI want to support a local charityOtherPlease provide details Stay in touch We may stay in touch with you by post, phone and social media with news from the hospice, information about events you might be interested in and other ways you can support terminally ill children. If you would also like to hear from us by email, please tick below.Email Opt In Yes, I'm happy to receive emails from Helen & Douglas House We take your privacy seriously. For more information about what we do with your data, please read our privacy policy at www.hdh.org.uk/supporter. You can opt-out of receiving this information, or having your data used in these ways, at any time by contacting us on fundraising@helenanddouglas.org.uk or 01865 799150.This field is hidden when viewing the formHidden
