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| Cheque/Postal
Order Donation
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When you have filled in your details, please print the form,
make out a cheque to MEDASSET/UK and send to the address
below. We will confirm receipt of your mail directly. |
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You must fill in fields marked with * |
| *
I wish
to give
£
to MEDASSET |
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Name |
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| *
Surname |
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* Mailing address |
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* Country |
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Postcode/Zip code |
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Telephone |
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Fax |
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* Email address |
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Tick the box if you are a UK taxpayer and want
MEDASSET UK to claim back the tax on your gift. (Please
note that you must pay an amount of income tax or capital
gains tax at least equal to the tax we reclaim on your donations
in the tax year)
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Tick here
if you wish for your e-mail to be added to the MEDASSET
mailing list |
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Please
send this form to:
MEDASSET/UK
c/o 24 Park Towers
2 Brick st.
London W1J 7DD
United Kingdom |
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