Adrienne Levy Memorial Page

£15 £30 £50 £100

I confirm that I am UK taxpayer and I understand that if I pay less income tax and/or capital gains tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay the difference.

Please read and confirm the following statements:

This is my own money. I am not paying in donations made by a third party, e.g. money collected at an event, the pub, a company donation or a donation from a friend or family member

I am not receiving anything in return for my donation, e.g. book, auction prize, ticket to an event

I am not making a donation as part of a sweepstake, raffle or lottery

House Number

Postcode