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 give my consent for GAT to regularly contact me.
Annual JSC donation is just £15.00
[  ]  I am making a one-off donation but don't want regular contact.
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 2014.

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, Retired Surgeon and GAT Trustee.