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Please fully complete the form below. Note that the details that you provide will be passed to PayPal exactly as you enter them here. Please ensure that your name and address details match those of the credit or debit card that you intend to use to make your payment, so that we may verify your address.

Title

Forename(s)

Surname

Address

Address line two (if required)

Town or city

County

Postcode

Email address

Telephone

Donation amount £

Declaration
By submitting this form, you are declaring that the above details are true and accurate; that you are a voter on a UK electoral register; and that you are making this donation on your own behalf, and not acting as an agent or proxy for any third party.


Note On Contact Details
The reason that we ask for your telephone number and email address on the form above is to enable us to contact you should there be any issue with your donation. We will not share these details with any third party other than PayPal, unless required to do so in order to comply with electoral legislation, nor will we use them to contact you unless we need to in regard to this donation.