Please print this page, complete and return to the following address:The Anita Goulden Trust,
144 Bronsart Road,
London, SW6 6AB, UK.
Please find enclosed a cheque/postal order (Payable to The Anita Goulden Trust)
for the amount of £………
Receipt Required?: Yes No
I am eligible for Gift Aid?:* Yes No
*If Yes please fill in the Gift Aid form as well