SPONSORSHIP FORM - Poole Festival of Running

SPONSORSHIP FORM
Race Title:
Name:
Address:
Postcode:
Telephone No:
Email:
Amount raised:
Date paid into PHC:
Office use only:
Chq £
Cash £
Via Justgiving £
Total gift aid claimed: £
Making your sponsorship money go further…The Gift Aid Scheme increases the value of your donation at
no extra cost to you. For every £1 you give, the government will add 25p. All you need to do is complete your
full name and address below and tick the Gift Aid box. We, who have given our names and addresses below,
and who have initialled the box entitled ‘Gift Aid?’, want the above charity to reclaim tax on the donation
detailed below, given on the date shown. We understand that each of us must pay income tax or capital gains
tax equal to the amount being reclaimed by the charity (currently 25p per £1 given).
Initial & Surname
Initial & Surname
Initials
A N Other
First Line of Address
£
Postcode
ANO
123 Your Street
A1 2YR
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
First Line of Address
£
Postcode
Initial & Surname
£
Postcode
Initial & Surname
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
First Line of Address
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
First Line of Address
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Please return your sponsorship form and collected monies by 8 July 2016
to Poole Hospital Charity, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB
01202 448449, [email protected], poole.nhs.uk/fundraising Charity Number: 1058808
Your details will only be used in connection with our charitable activities and will not be disclosed to any third party.
Initial & Surname
First Line of Address
Initial & Surname
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
First Line of Address
£
Postcode
Initial & Surname
£
Postcode
Initial & Surname
£
Postcode
Initial & Surname
£
Postcode
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
First Line of Address
£
Postcode
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
First Line of Address
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
Initial & Surname
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
First Line of Address
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Initial & Surname
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
First Line of Address
£
Postcode
If you would like to receive further information from the charity, tick here [ ]
Please return your sponsorship form and collected monies by 8 July 2016
to Poole Hospital Charity, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB
01202 448449, [email protected], poole.nhs.uk/fundraising Charity Number: 1058808
Your details will only be used in connection with our charitable activities and will not be disclosed to any third party.