BUY A FOREVER BUTTERFLY I would like a Forever Butterfly in memory of:

Name:

Name:

Name:

£35 could fund one hour of 1-2-1 time with a sibling worker for a brother or sister to relax and talk with someone who understands how they’re feeling.

Relationship to you:

Relationship to you:

Relationship to you:

£70 could help fund a Memory box containing precious keepsakes such as a hand or foot cast that can bring comfort to a family who is grieving.

Your details (please print in BLOCK CAPITALS)

Title

Address

First Name (in full) Surname

£105 could help fund two tailored counselling sessions for a bereaved family helping a child, sibling or parent through difficult and challenging times.

Email

Yes, I am happy to receive email updates about Julia’s House news, events and appeals

Postcode

Telephone

You are free to change your mind at any time about how we may contact you, for example if you no longer wish to receive postal information. Simply call our Supporter Care team on 01202 644220. Your details are safe with us and we will never sell or share them with anyone else. To find out more about how we use your data, view our Privacy Policy: juliashouse.org/privacy

Please confirm how many butterflies you wish to purchase: £35 for 1 £70 for 2 £105 for 3

Free collection from Creekmoor Salisbury Or post (£4.50)

Your Forever Butterfly can be collected from the above shops between 29th May and 11th June, 10am–4pm. If you select postage, £4.50 will be added to your total. Please note: all butterflies are blue and will not be personalised or engraved.

Payment details

Cardholder’s Name(s)

Card Number*

Please make cheques payable to Julia’s House or fill in your card details below

Card Type Visa Mastercard

Expiry Date* 3 Digit Security Number* /

*This information will not be kept on file and will be destroyed once processed.

If you would like to set up a regular donation in memory of your loved one, please tick this box. A member of our team will call to set up a direct debit. Thank you.

If you wish to purchase more than three butterflies, please call us on 01202 644220

T&Cs are available at juliashouse.org/foreverbutterflies

Please return this form to Freepost Julia’s House (that’s all that needs to be on the envelope). Thank you!