Keech 21st birthday book purchase form

Please complete your details below to purchase your 21st birthday book.

Please indicate on the form whether you would like to pick up the book from the hospice or your nearest hospice shop or whether you would like us to post it to you at a cost of £5.50.
(Nb. Unfortunately we have had to increase the cost of p&p due to postal cost increases).

Once you have clicked 'Continue' you will be taken to RBS Worldpay's secure servers.

KEECH HOSPICE CARE (TRADING) LTD (Registered in England and Wales), GREAT BRAMINGHAM LANE, STREATLEY, LUTON, BEDFORDSHIRE, LU3 3NT Company No. 06941924

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First Name *

Surname *

Billing address *

Line 1 *
Line 2
Town *
County
Postcode *
Country

Tel. number (daytime) *

Mobile no.

Email *

Where did you hear about the Keech 21st Birthday Book?

Payment

I agree to pay £14.99 to purchase a copy of the Keech 21st Birthday Book. *

Delivery or collection? *

Delivery Address

Which Keech shop would you like to collect your book from? Type 'hospice' if you would like to collect it from the hospice.

Refunds

You have the right to cancel within 7 days of purchase. Upon cancellation your card will be refunded. Please contact Katy Toner on 01582 497842 or email ktoner@keech.org.uk to arrange returns. Please check the box to confirm you have read this cancellation/refund policy. *

Data protection

Keech Hospice Care will not share your details with any third party organisations. We would like to contact you from time to time about our fundraising activities and other information that we feel may be of interest to you. If you are happy to receive this information:

By post, tick here
By email, tick here
By telephone, tick here

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Keech 21st birthday book purchase form