St Lukes Hospice 2000 Club

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I want to Join St Lukes Hospice 2000 Clubs with a monthly donation of

R50 for 1 numberR100 for 2 numbersR150 for 3 numbersR200 for 4 numbers

Name (required)

Address (required)

Postal Code (required)

Email (required)

Telephone (required)

I.D Number (required)

Preferred Payment Method

I wish to donate the amount marked by Debit Order from:

and each month thereafter until cancelled by me


Branch Code

Account Number

Account Type

OR I prefer to make a one-time payment of:

600120018002400Cheque EnclosedPlease debit Credit Card as aboveDirect Deposit

Credit Card Payment

Please debit my Credit Card monthly until cancelled by me.

Expiry Date


Direct Deposit to:

Account Name: St Lukes Hospice
Bank: NedBank
Branch Code: 123-209
Account No: 1051886309
Account Type: Current

Please use your name as reference

Type in the password below

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