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Sponsorship Form
Walkers Name: ____________________________
The funds raised by me will support the following charity: Charity Name: ______________________ Reg. Charity No. ____________
GIFT AID: Using Gift Aid means your gift will be worth 25% more to us! If you are a UK tax payer and you would like our charity to benefit from this scheme, please tick the box. (You must also give us your full name, address and postcode!)
Amount Gift Aid
Full Name
Address
(House Number or Name - and/or Telephone number)
Post Code
Paid
Organised by Xenophon Kelsey, MBE. 20 Mallorie Park Drive, Ripon, HG4 2QD Tel: 01765 601074/602856 Mob: 07974 698265 Web: www.xenmus.net Email: xen@xenmus.net or find me on Facebook