Make a One-off Donation to The Christie charity I would like to make a single donation of: Amount: £ * Would you like your donation to be used for a specific need: Wherever it's needed most Advanced 3D Interventional Radiology System Integrated Procedures Unit Proton Beam Research Cancer Research Molecular Diagnostics Activity Fund for the Teenage and Young Adult Unit Adult Brain Tumour Fund Colorectal and Hepatobiliary Research Experimental Cancer Medicine Team Genitourinary Research Haematology and Transplant Unit Leukaemia Research Lymphoma Research Manchester Cancer Research Centre - Research Posts Melanoma Research MR Linac Accelerator Pseudomyxoma Psycho-oncology Rehabilitation Development of Patient Centred Research Gift aid and staying in contact with The Christie charity: Frequency: Weekly Monthly Quarterly Annually On: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting: Ending: Ending: Corporate: This donation is on behalf of a company Please tell us about what prompted you to donate today: Gift Aid: I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I am a UK taxpayer and understand that if I pay less Income tax and /or Capital Gains Tax than the amount of Gift Aid claimed it is my responsibility to pay any difference. I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2012 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2016. What is Gift Aid? How did you hear about us?: <Please select> Word of mouth Newspaper TV Radio I received a letter from the Christie Other * If other please specify: Your details: Please note that this address should be the address your payment card is registered at. Title: Dr Master Miss Mr Mrs Ms Professor Rev Sister * First name: * Surname: * Country: Australia Austria Belgium Canada Cyprus Denmark Dubai France Germany Hong Kong Ireland Israel Italy Japan Malta Monaco Netherlands New Zealand Northern Ireland Norway Pakistan Poland Portugal Qatar Saudi Arabia Scotland Singapore South Africa Spain Sweden Switzerland Tanzania Thailand Turkey UAE United Kingdom USA * Postcode: * House number and street name: * City: * County: County Londonderry Aberdeenshire Anglesey Angus Antrim Any County Argyll Avon Ayrshire Banffshire Bedfordshire Berkshire Berwickshire Buckinghamshire Caerphilly Cambridgeshire Carmarthenshire Central Scotland Ceredigion Cheshire Clackmannanshire Cleveland Clwyd Co Antrim Co Armagh Co Clare Co Cork Co Derry Co Down Co Dublin Co Durham Co Fermanagh Co Kerry Co Londonderry Co Louth Co Mayo Co Meath Co Offaly Co Tyrone Co Waterford Co Wicklow Conwy Cornwall County Antrim County Armagh County Down County Durham County Fermanagh County Leitrim County Tyrone Crete Cuddington Cumbria Denbighshire Derbyshire Devon Dordogne Dorset Dumbartonshire Dumfrieshire Dumfriesshire Dunbartonshire Durham Dyfed East Dunbartonshire East Lothian East Sussex East Yorkshire EDINBURGH Essex Fife Flintshire Fylde Glamorgan Glasgow Gloucestershire Greater Manchester Guernsey Gwent Gwynedd Hampshire Herefordshire Hertfordshire Highland Humberside Inverness-shire Isle of Anglesey Isle of Man Isle of Skye Isle of Wight Jersey Kent Kincardineshire Kirkcudbrightshire Lancashire Leicestershire Leid Lincolnshire Lothian Lothians Manitoba Merseyside Mid Glamorgan Middlesex Midlothian Monmouthshire Morayshire Near Wrexham Norfolk North Ayrshire North Humberside North Lanarkshire North Wales North Yorkshire Northamptonshire Northumberland Not known Nottinghamshire Orkney Oxfordshire Peeblesshire Pembrokeshire Perthshire Powys Renfrewshire Rochdale Roxburghshire RUTLAND Sample County Selkirkshire Shetland Islands Shropshire SK3 9PX Somerset South Ayrshire South Glamorgan South Humberside South Wales South Wirral South Yorkshire Staffordshire Stirlingshire Stoke-on-Trent Strathclyde Suffolk Surrey Sussex Sutherland Tameside Tayside Tyne & Wear Tyne and Wear Vale of Glamorgan Warwickshire Waterford West Glamorgan West Lothian West Midlands West Sussex West Yorkshire Wigtownshire Wiltshire Wirral Worcestershire Wrexham Yorkshire Manama OL6 6PS Rhondda Cynon Taff M7 1RG SK6 7GF Virginia Helsinki Graeter Manchester Nouvelle Aquitaine Phone: Email: * Your card details: Cardholder's Name: * Card Number: * Card Type: Visa Maestro MasterCard * Valid From: 01 02 03 04 05 06 07 08 09 10 11 12 / 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 (Maestro/Switch/Solo only) Card Expiry: 01 02 03 04 05 06 07 08 09 10 11 12 / 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 * Issue Number: (Maestro/Switch/Solo only) Card Security Code: * Note: The Card Security Code is not required for Maestro, Switch and Solo cards.