PLEASE PRINT OUT THIS FORM TO MAKE AN in memoriam GIFT

Full name and title (Mr / Mrs / Miss / Ms / title) of deceased in block capitals
...............................................................................................................

If known date of birth date of death and age of deceased.

DoB............................... DoD............................ Age.......................

The name of the deceased together with the above details, if provided, are inscribed in our Book of Remembrance for posterity. The Book of Remembrance is available for viewing at our head office: Cobden House, 231 Roehampton Lane, London SW15 4LB and was established to provide a permanent memorial for departed loved ones, friends and relatives.
If you wish to send a photo (or photocopy of a photo) of the deceased we shall also include it in our Book of Remembrance.

Next of Kin

On receipt of your in memoriam donation we write to you enclosing our official receipt confirming receipt of your letter and donation. If applicable, we also write to the next of kin informing them of your in memoriam gift; (the amount is not mentioned). We send a copy of this letter to you as well.

Name, address and relationship, (if applicable), of next of kin: ................................................................................................... (...............................)

Cancer Prevention Research Trust, Cobden House, 231 Roehampton Lane, London SW15 4LB

for donations, in memoriam gifts, legacies

Cancer is a preventable disease.

Registered Charity No. 265985

E-mail:mail@cancerpreventionresearch.org.uk

[Cancer Prevention Research] [The Causes of Cancer]
[Guidelines to Avoid Cancer] [in memoriam gifts] [Donations]