Donations

Could you pay for a day, or more, that will help support the despairing in our community? Any amount will be gratefully received.

Simply fill in the form below, print and send it in with your cheque to Samaritans, 2 Rose Hill, Chesterfield, S40 1LW.
Cheques should be made payable to Chesterfield Samaritans.
Information in this form will remain confidental to Chesterfield Samaritans, and will not be shared with any third party
Alternatively you can use the Samaritans Credit Card number - 08709 0060 32 (specify for Chesterfield branch).

Title	Mr Ms Miss Mrs Dr
First name
Surname
Date	/ /
Address
Town/City
County
Postcode
Country
E-mail address
Telephone

I would like to Donate		£
Would you like your donation to go towards a particular purpose, other than general running costs, or would you like to sponsor the branch on a day of importance to you (a birthday, holiday, etc) at £50 a day? Please Specify:
Can we contact you about your donation by (please tick all that apply): Phone E-mail Letter

Cheques should be made payable to Chesterfield Samaritans.

Print a copy of this form and post it along with your cheque to: Samaritans, 2 Rose Hill, Chesterfield, S40 1LW