Donation Form

Brian Martin's Cycle Ride Across Australia, August/September 2008

Raising Funds for the WaterAid charity (Charity Reg. No 288710)

TITLE (Mr/Mrs/Ms/Dr/other): .................
FIRST NAME: ..........................................
SURNAME: .............................................

ADDRESS: ..................................................................................
.................................................................................................
.................................................................................................
......................................................... Post/Zip Code:.................

TELEPHONE: ...................................
E-mail Address: ................................................................

My donation to WaterAid is: £ ..............

GIFT AID: I would like WaterAid to reclaim the tax on this and any donation I have made
over the last six years and all future donations until I notify you otherwise. I confirm
I am a UK taxpayer and that I pay as much income or capital gains tax as WaterAid
will reclaim in the tax year (currently 28p against every £1 donated).

YES I am a UK taxpayer [tick]:

Please make your cheque payable to WaterAid and send it to:

Brian Martin, WaterAid Fund-Raising, Riscombe Farm, Exford, Minehead, Somerset, TA24 7NH, England

Signed: ...................................................... Date: ......................................

Thank you for your support. I will send you a receipt.

Brian Martin