form

I would like to make a donation of £:
Title
Surname
Forenames
Home address
Postcode
Membership no. (if applicable)
I enclose a cheque/postal order for £:
	Made payble to: RSPCA Southport, Birkdale & District Branch
Being a taxpayer, I want the RSPCA to reclaim tax on all my donations. Please treat all donations made by me after the date of this Declaration as GIFT AID DONATIONS.
Signed .........................................................	Date .................................

Please send this completed and printed form to:- The Branch Secretary, RSPCA Animal
Shelter, New Cut Lane, Birkdale, Southport, PR8 3DW.