Donation form

Thank you for your interest in donating to Down Syndrome Education International.

To make a credit or debit card donation to Down Syndrome Education International (registered charity number 1062823), please print and complete this page (in CAPITALS and black ink) and return it to us by post or by fax.

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1. Your name

Your title (Mr/Mrs/...): ____________

Your first name(s): __________________________________________

Your last name: _____________________________________________

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2. Your contact details

Address Line 1: __________________________________________________________

Address Line 2: __________________________________________________________

Address Line 3: __________________________________________________________

City/Town: __________________________________________________________

County/State: __________________________________________________________

Post code/Zip code: ___________________________________________

Country: __________________________________________________________

Telephone number: _________________________

Alternative telephone number(s): ___________________________________

Please enter your e-mail address (if any): __________________________

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3. Donation amount

Please enter the value of the donation that you wish to make:

GBP £_____________

USD $_____________

EUR €_____________

Payment details

Please charge my card as follows:

Card type:      [  ] Visa          [  ] MasterCard          [  ] Maestro          [  ] Solo - issue no: ____

Card holder name: _______________________________

Card number: _____________________________

Card expiry date:  Month:_______  Year:________

Card issue date (if shown on card):  Month:_______  Year:________

Card issue number (if shown on card): _______

Card verification number: ______
(last 3 numbers printed on signature strip)

Card holder signature: ____________________________  Date: ______________

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4. Gift Aid declaration - UK tax payers

Using Gift Aid means that for every pound you give, we get an extra 28 pence from HM Revenue & Customs, helping your donation go further, and it doesn't cost you a thing. If you are a UK taxpayer, please Gift Aid your donations:

I want the charity to treat (please select):

[  ] all donations I've made to Down Syndrome Education International since 6 April 2000 and all donations I make in the future until I notify you otherwise

[  ] all donations I make from this date

[  ] this donation only

as Gift Aid donations.

I am a UK taxpayer and will advise the Trust if this situation changes. I understand that the amount I pay in income tax or capital gains tax must at least equal the amount the charity reclaims in that tax year.

Signed: _____________________________    Date: ______________

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5. Keep informed

If you would like us to keep your contact details on file and inform you of new services and activities that may be of interest to you, please tick all statements that apply below:

[  ] I am a parent/guardian of a person with Down syndrome

[  ] I am a relative (other than parent/guardian) of a person with Down syndrome

[  ] I am a professional (teacher, doctor, speech therapist, charity information worker, etc.) involved in the education/development/care of people with Down syndrome

[  ] I am a researcher interested in Down syndrome

Privacy and Data Protection: By selecting any of the above statements you are consenting to the Down Syndrome Educational Trust storing the information that you have provided for the purposes of keeping you informed of new services and activities that may be of interest to you. We will not divulge this information to any third parties. If you do not want to receive information from the charity, please tick this box [  ].

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6. Fax or post this form

Print this form and either:

• fax it to us on: 023 9285 5330 (inside UK) or +44 23 9285 5320 (outside UK)
• or post it to us at: Down Syndrome Education International, The Sarah Duffen Centre, Belmont Street, Southsea, Hampshire, PO5 1NA, England.