I would like to become a regular supporter of the Pelvic Radiation Disease Assocation (£30 p.a)

First Name
Last Name
Address 1
Address 2
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.