Please Print This Form and Send to:

Terrie McCann, The Vascular Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London, WC2A 3PN

Circulation Foundation Donation Form:

I want to give to the Circulation Foundation:

DETAILS OF DONOR:

Title_____________________________

Forename(s)______________________________________________________________________

Surname_________________________________________________________________________

Home Address (for gift aid purposes)___________________________________________________

____________________________________________________Post Code ___________________

Please pay: The Circulation Foundation (Sort code: 40-52-40, a/c 00014047)

the amount of £_____________________ with the first payment to

be taken on the_________________________________________________________

and the same sum on the same day annually/quarterly/monthly*, (*delete as appropriate)
until such time as I give notice in writing.

Sort code: ___/___ /___ Account number: ____________________________

Name of Bank____________________________________________________________________

Bank Address:___________________________________________________________________

____________________________________________________Post Code__________________

I wish to make a single gift of £__________________________

I enclose a cheque/postal order made payable to : The Circulation Foundation

Signed__________________________________________ Date___________________________

I am a UK taxpayer and I would like the Circulation Foundation to treat all donations I have made (backdated to 6th April 2000) or will make in future until I notify you otherwise, as Gift Aid donations. I am currently paying income tax or capital gains tax that is equal or more than the tax deducted from my donation. (Please tick, sign and date)

The Circulation Foundation is an operating division of the Vascular Society, a charitable company
limited by guarantee, company number 5060866 and registered charity number 1102769.