Your details

I wish to remain anonymous

Title

(Dr, Ms, Mr, Mrs, Miss, etc)

Forename

Surname

Your address

Post code

Email

Telephone No.

I wish to join the monthly fundraising e-newsletter with stories, events and ideas

Your donation

You may specify the fund or funds in which you wish your donation to be placed, or you can make a donation to Crohn's and Colitis UK's Unrestricted Fund which the Trustees may then apply to any aspect of our work.

Unrestricted Fund (enables us to use your donation where it is most needed)

£

Information and Support Services

£

Welfare Fund

£

Research Fund

£

Children and their Families (support and research)

£

TOTAL Donation

£

What type of donation are you giving?

A donation in memory of someone.      Name of person:

May we disclose your donation to the family?

Yes No

Please give the contact name and address and their relationship to the deceased

A donation in lieu of a gift to someone.      Name of person:

May we let them know you have donated?

Yes No

Please give their address and the occasion (eg birthday)

A general donation

Money you have raised

Please let us know what you did

Please note that we do not disclose the amount for donations given in memory or in lieu of a gift

Tax Status

Do you pay UK income or capital gains tax?

Yes No

Answering yes to this question will print a Gift Aid Declaration form with your donation form.  Completing this form and sending it to Crohn's and Colitis UK will allow us to reclaim your tax on your donation.  This can add 25p for every £1 you donate at no cost to you.  If you answer 'Yes' then you must enter your name and address details above in order that the form can be completed.

How would you like us to acknowledge your donation?

I do not wish to receive an acknowledgement

By post

By email