Friends of the Hospital

If you would like to join Friends, please print and fill in the form below and send it to St. Luke's Hospital for the Clergy, 14 Fitzroy Square, London W1T 6AH.

I would like to join Friends of the Hospital and I enclose:

£10.00 for the year                  ....... 
£100.00 for Life Membership     .......

I do not wish to join Friends of the Hospital, but wish to make a donation of £...............

Name..................................................................
Address.......................................................................................................................
...................................................................................................................................
Home phone number.................................Work phone number.................................
E-mail address....................................................

I am a tax payer and I would like the donation to be treated as Gift Aid .......

I enclose a cheque (made payable to St. Luke's Hospital for the Clergy) for £...............
OR
Please charge my Visa/MasterCard
No.......................................... Exp. Date........................................
Title................. Name....................................................................
Address..........................................................................................
................................................Post Code......................................
Signed...........................................................................................