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					 Yes, I would like to support radiological research
Please complete this form, attach your donation and post to:
The Radiological Research Trust, 36 Portland Place, London, W1N 3DG, UK


  Title: ________ Initial(s): _________ Surname: ______________________________


 Address: ____________________________________________________________


 ________________________________________ Postcode: __________________


 Email: _____________________________ Amount of Donation £ ______________
 I enclose a cheque/postal order/credit card authorization payable to: The Radiological
 Research Trust. Please debit from my Mastercard/Visa/CAF CharityCard/Switch
 (delete as appropriate).

 Card No.                                               
                                                                                  (Switch/Maestro)

    Card security code (last 3 digits on the back of the card)
 Valid From: _______/________ Expiry Date: _______ /_________


 Issue No.      (Switch/Maestro) Signature: _________________________________


                             Tick here to make your donation worth more

  I am a UK taxpayer and would like The Radiological Research Trust to reclaim tax
 on this donation, and all other donations I make hereafter. I confirm that I pay an
 amount of income tax and/or capital gains tax at least equal to the tax that the charity
 will reclaim on my donations in the tax year. Date: ______/ _______ /________
Your data is managed in strict accordance with the Data Protection Act (1998). We would like to keep you
informed about our activities. If you would rather not receive such information please tick here. 

Registered Charity No. 2922828 Est. 1985                    www.radiologicalresearchtrust.org

				
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posted:11/8/2011
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