Donation Form

Please print this form out and return with your donation to:-

Name:	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: Postcode:	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Please tick boxes as appropriate:-
	I enclose a donation of £ . . . . . . Please make all cheques/postal orders payable to LEEDS & DISTRICT M.E. GROUP
	I would like a receipt and have enclosed a stamped self-addressed envelope
Gift Aid Declaration
	I would like the Leeds & District ME Group to reclaim the tax I have paid on this subscription/donation Note: You must pay a sum of Income or Capital Gains Tax equal to the tax reclaimed on this donation and ALL other Gift Aid donations you make in the tax year (currently 28p for every £1 you give).
	Date of Declaration: . . . . . . . . . Signed: . . . . . . . . . . . . . . . . . . . . . . . . .