Online form

Please fill in this short form to order a memory leaf in memory of a loved one. Once you’ve completed the form, simply click submit and a member of the team will be in touch.

Your message

Please write your dedication to your loved one in the box below. Your dedication can be up to a maximum of 50 characters including spaces. Please check carefully as any text inputted here will be engraved on to your leaf.

Memory Leaf Options:

St Catherine’s Hospice will keep your details safe and secure. We will not sell or share your information.

We’d love to keep you updated about our work and how you are making a difference to the people we support. We would also like to send you information about our work and other ways in which you can help support.

More information on how we use your data can be found in our privacy statement, which is on our website at

Please also see our: Terms and Conditions

By returning this form, I confirm I am aware of the privacy policy and accept how St Catherine’s will handle my information.

For further details or a copy of our statement, or if you would like to change your preferences on how we contact you, please call one of our Supporter Services team on 01293 447360