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Donation Form

This form needs to be printed and completed and cannot be emailed direct to National Office. Please click the 'print' button above.

Title: Mr. Ms. Mrs ................... First name .........................................................

Surname:.............................................

Amount of donation ................................

Address:..............................................................................................................

.........................................................................................................................

Postcode: ....................................... Tel:............................................................

GIFT AID DECLARATION
I wish LUPUS UK to treat any donations made by myself as Gift Aid donations.

Signature..........................................................................................

Date......................................................

I confirm I pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on my donations in the tax year (currently 25p per £1, plus a Government supplement of 3p per £1 until 5th April 2011)

I would also be interested in Volunteering Opportunities for LUPUS UK and/or my Regional Group
(please tick) 

IF WISHING TO REMIT BY STANDING ORDER, PLEASE TELEPHONE FOR THE INSTRUCTION FORM

PLEASE COMPLETE RELEVANT SECTIONS OF THIS FORM AND SEND TO:
LUPUS UK, St James House, Eastern Road, Romford, Essex RM1 3NH
Tel: 01708 731251 Fax: 01708 731252