CLIC Sargent - Caring for Children and Young People with Cancer : Registration form

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I would like to set up a fund in the following name(s):

If not you, please state your relationship *

Title *

First name *

Surname *

Address line 1 *

Address line 2

Address line 3

Town

County

Postcode *

Telephone number

Mobile number

Email address *

Date of birth (to establish if you are under 18 only) *

Do you have experience of childhood cancer?

What is your reason for creating the Fund?

If other, please specify:

How did you hear about Especially For You funds?

Would you be happy to help with any media promotion, eg in newspapers or radio?

Please tick this box if you do not want CLIC Sargent to post information to you abour our work

Please tick this box if you do want CLIC Sargent to send you emails about our work

* Mandatory field

Additional Help

I would like CLIC Sargent to claim back the tax on all donations I have made in the last 6 years and until further notice. I pay as least as much Income or Capital Gains Tax as CLIC Sargent will reclaim.: We would like to maximise any donations that you make to CLIC Sargent by claiming Gift Aid (currently this is an extra 28p against every £1 donated). In order for us to do this, please read and tick the box if it applies to you.Return to field (id:weo2)

Page Last Modified: 15/06/2011

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