Your chance to change people's lives

I would like to help Hampshire Deaf Association make a difference in people's lives.

Please accept my gift of: £ ____________

Name: _____________________________________

Address: _______________________________________________________

_______________________________________________________________

_________________________ Postcode _____________________________

I enclose my cheque made payable to Hampshire Deaf Association

OR please debit my Access/Visa/CAF card account by £ ___________

Account No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiry Date: ___ / ___ Signature: _______________________

Please return this form with your donation to: Hampshire Deaf Association

1 & 2 Carlton Commerce Centre, Dukes Road, Southampton SO14 0SQ.

Under the new Gift Aid Scheme we can reclaim tax on any donations you make now or in the future. This will add 28% to the value of your gift if you are a UK tax payer. To make your gift worth an extra 28% more please complete your name and address above and sign and date the declaration below.

I am a UK tax payer and I declare all the donations I make to Hampshire Deaf Association on or after this date to be Gift Aid donations.

Signed _____________________________ Date ________________________

Hampshire Deaf Association aims to ensure that deaf and hard of hearing people have full and equal access to the world in which we live.

Registered Charity No. 106 5669