I would like to become a regular supporter of the Pelvic Radiation Disease Assocation (£25 p.a) First Name Last Name Address 1 Address 2 City County Postcode Email Telephone Message/comments Gift Aid Please tick this box if eligible. I am a UK taxpayer and would like PRDA to claim back tax on my membership fee and any donations I have made for the six years prior to this and all donations I make from the date of this declaration until I notify you otherwise. I understand that I must pay an amount of income tax or capital gains tax at least equal to the amount to be reclaimed by the Charity. Please tick as appropriate: I have sent my bank a Standing Order instruction. I have sent a cheque to PRDA at PO Box 602, Epsom, KT17 9JB. You can download a Standing Order instruction form for your bank here. A Standing Order is a great way to help us. If you would like a paper version of the application form you can download it here.