Fat Bloke on a Bike

PLEASE PRINT OFF THIS FORM AND SEND IT WITH YOUR CHEQUE

I would like to help, and enclose a sponsorship cheque for £____________

(Please make cheques payable to Mji wa Neema Orphanage)

Signed :______________________________

If you would like to be sent an email report after the ride, please tick the box:

5 (R). Email address:

_________________________________

Name:_______________________________

Address:_____________________________

____________________________________

____________________________________

_____________________________________

Using gift aid means that for every pound you give, we get an extra 28 pence from the Inland Revenue, helping your donation go further.

If you are a UK tax payer, and you want your donation to go further please tick the box below.

I want all donations I've made since 6 April 2000 and all donations in the future to be Gift Aid until I notify you otherwise 5 (R).

(To qualify for gift aid, what you pay in income tax or capital gains tax must at lease equal the amount we will claim in the tax year.)

Please return this form with your donation to:

Mark Mitchell

Cottage 2, Little Float

Sandhead

Stranraer

DG9 9LD

Phone: 01776 830242

email: mark@fatblokeonabike.org.uk

Mji wa Neema Orphanage, UK registered charity No: 1099611