Back to Home Page

Click here to view this form as a PDF document

To: Gloucestershire Arthritis Trust,
       Parkside, Cheltenham General Hospital,
       Sandford Road, Cheltenham,
       Gloucestershire, GL53 7AN

Full Name: …………………………………………………………………………………
Address: ……………………………………………………………………………………
……………………………………….……………………………………………..…………
Post Code .……………………
Email: …………………………………………………………………………………………

[  ]  I want to become a member of GAT’s "Joint Supporters' Club" (JSC)
and help other people get their lives back on track.
Annual JSC donation is just £15.00
[  ]  I want to add/make a one-off donation.
I enclose a cheque to the value of: £ ……………………………….
Make cheque payable to Gloucestershire Arthritis Trust, or GAT.

Signed ………………………………………….… Date …………….…………

Gift Aid adds extra

HM Revenue & Customs GIFT AID scheme enables charities to receive an extra 25p
in every £1 from qualifying donations.
If you wish GAT to benefit, please tick all boxes that apply and sign the declaration below:

[  ] Today      [  ] In the past 4 years      [ ] In the future

I confirm I have paid, or will pay, an amount of Income Tax and/or Capital Gains Tax
for each year (6th April to 5th April) that is at least equal to the amount of tax
that all the charities that I donate to will reclaim on my gifts for that tax year.
I understand that other taxes such as VAT and Council Tax do not qualify.
I understand GAT will reclaim 25p of tax on every £1 that I give after 6th April 2009.

Signed ……………………………………………………………… Date ……………………

"Thank you for any support you can give. It will help us to help even more people
get their lives back to normal."

Guy Rooker, Surgeon and GAT Trustee.