Light up a Life dedication form

Make your dedication and donation by completing the form below.

Please add the names of the person your dedication is for below (one per line).
Each dedication will be acknowledged by a commemorative card which will include the name of those you have remembered in this special way. This card is yours to keep or pass on to friends or family if you wish.
Please indicate whether or not you would like us to keep in touch. You can change your preferences at any time by visiting:
Our Light up a Life ceremonies are offered free to the local community. By making a donation today you will help to cover the costs of our nursing service throughout the Christmas period and into the future.Thank you.

Please click below to submit your dedication(s) and make your Light up a Life donation.

Data Protection: We take data protection very seriously and will never sell your personal data to a third party. For further details go to; We promise to protect your privacy and will manage all information you give us in accordance with the Data Protection Act (1998)