First Name*
    Last Name*
    How Can We Help?*
    Address line 1*
    Address line 2
    City*
    County
    Postcode*
    Email*
    Telephone*
    Please tick to confirm*:
    I agree to my details being held in a confidential database that is only used for communications by the charity.
    By giving your email address, you are opting in to receive communications from PRDA. You can change your preference at any time by contacting us at info@prda.org.uk.

    If you would like to leave an additional message please comment below:

    I would like to become a regular supporter of the Pelvic Radiation Disease Association (recommended donation £5 per month)

    Gift Aid
    Please tick this box if eligible. I am a UK taxpayer and would like PRDA to claim back tax on 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 made a donation on the PRDA Charity Aid Foundation page
    I have sent my bank a Standing Order instruction.
    I have sent a cheque to PRDA at 62 Norbiton Avenue, Kingston upon Thames, KT1 3QP.

    If you would like a paper version of the regular donation form you can download it here.
    The form also includes details to set up a bank Standing Order.

     

    Modified: 17th December 2021

     

     

    [addtoany]