I would like to become a regular supporter of the Pelvic Radiation Disease Association (recommended donation £3 per month) 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 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 Virgin Money Giving 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 application form you can download it here. The form also includes details to set up a bank Standing Order.