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
    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 application form you can download it here.
    The form also includes details to set up a bank Standing Order.


    Modified: 23rd November  2021