Response
International Donation & Registration Form
Cheque Payment : Complete Section (A) + (C), Print and Return to: Response International Holland House, 4 Bury Street, London EC3A 5AW
Direct Debit : Complete All Sections, Print and Return to:
Response International
Holland House,
4 Bury Street,
London EC3A 5AW
Section (A) - Registration
Details
Title
Full Name
Address
1
Address
2
Postcode
City
E-mail
Tax Status:
UK tax payer
US tax payer
Other
In order for Response International
to benefit from the UK Gift Aid scheme, the donor must have
paid UK income or capital gains tax in the UK.
Please tick
here
If you would prefer not to be contacted
Section (B) - Bank
Details
AN OPPORTUNITY TO DONATE
You can help Response International continue working for
victims of conflict by making a regular donation.
I
would like to support Response International by donating :
each month until further notice.
Please debit this amount from the following account details:
Bank Name
Account
Number
Bank
Sort Code
-
-
Starting
on
Section (C) - Signature
Date
Signed
Your email will not be distributed in any way, nor will
you receive any unsolicited emails. An email address will
save us postage costs. We undertake not to flood you with
a constant stream of contact but infrequent updates on
events and urgent appeals only; nor will we distribute
your address to other databases without your permission.