Afasic Donation Form

You can now pay online if your prefer - visit our secure site.

I am pleased to make a donation towards the work of Afasic with children and young adults who have speech and language impairments as follows :

1. I am enclosing a cheque (payable to "Afasic") for £


2. Or Debit my credit card (Visa / Mastercard / American Express / CAF Card *) for £

Card Number ____________________________________

Expiry date   _ _/_ _

Signature     _____________________________ Date ______


3. Or I have completed a standing order form which is enclosed (see link below).

From
Name :
Address :



Email:

Reason for donation:



Don't forget, if you are a tax payer and send us a completed Gift Aid Declaration form we can claim a further 28p in the Pound from the Government on top of your gift! (see link below)

Thank you for your support.

Return freepost to :
FREEPOST RRUK-JSAT-CUGS, AFASIC, Olive House 1st Floor, 20 Bowling Green Lane, LONDON, EC1R 0BD

* Please delete as appropriate in each case


Standing Order Form

Gift Aid Declaration form