Declaration covers *

Just this donation

This and all future donations (and donations in the past 4 years)

Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gift Aid declaration *

I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to this charity/CASC. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference.