Request a collection tub :: East Lancashire Hospitals NHS Trust

If you are interested in displaying one of our collection tubs then please complete the form below:

Title Required

First Name Required

Last Name Required

Company (Please only enter if your collection will be at your workplace)

Address

Address 1

Address 2

City

State/Province

Country

Postal Code

Is this a company/school address? Required

Company

School

Other

Are you happy to be contacted by post? Required

Yes

Email Address Required

Email opt-in Required

I am happy to be contacted about your work and appeals via email

Daytime Telephone Number Required

I am happy to be contacted by telephone Required

Yes

Terms and conditions

I accept responsibility for my ELHT&me collection box. I undertake to use the collection box solely for the benefit of the East Lancashire Hospital Trust Charity (registered charity no. 1050478). I will return said box to the charity when the activity is complete, or when requested to do so by ELHT&me charity. I agree to abide by the statutory Laws regarding the Collection of Monies for their charitable purposes. I am 16 years of age or over.

Please tick the box to accept the terms and conditions above Required

I accept

Data protection

The charity will hold the information you give us for communication, marketing and administration purposes in accordance with the Data Protection Act 1998. If you do not wish to receive appeals from the charity in the future, please call Denise Gee 01254 732140

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