Please copy and paste this form onto a Word document and complete your details
then either email or mail it to me at this address:
Sue Owen
PO Box 2630
Marlow
Bucks SL7 2SB

I would like Sue Owen to wear this name or names on her tee shirt in the Race for Life:

(Please print)
In Celebration of: ______________________________

In Memory of: ______________________________

I enclose a donation of £______ in the form of a cheque or postal order made payable to Cancer Research UK/
I have made a donation via PayPal.

If you are a UK taxpayer, under the Government’s Gift Aid scheme Cancer Research UK can reclaim the tax you have already paid on your gift. This means that your donation can increase in value by nearly a third at no extra cost to you.

Please tick the statement below if you would like Cancer Research UK to reclaim the tax on your gift.

____ Please treat this and any future donations I make to Cancer Research UK and all payment I have made to The Cancer Research Campaign and/or Imperial Cancer Research Fund from 6th April 200 as Gift Aid donations.

Name: __________________________________

Address: __________________________________

__________________________________

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Postcode: __________________________________

Please tick here ___ if you would prefer not to receive other forms of communication about the future activities of Cancer Research UK.