DONATION FORM
 
I would like to help a child overcome dyslexia by making a gift of: Please send me more information about the Dyslexia Institute
£5     £10     £15     £20  

£Other ..............   

 Please tick this box if you would like us to reclaim the tax (currently worth 28p in the pound) from the enclosed donation

In order for us to claim the tax back from the Inland Revenue you must pay an amount of income tax and /or capital gains tax at least equal to the tax that the Dyslexia Institute or the Dyslexia Institute Bursary Fund reclaims on your donation in the tax year.
To  The Dyslexia Institute                        
or  The Dyslexia Institute Bursary fund  I am making my donation by:
(Please tick as appropriate) Cheque      PO       Visa      

Access       CAF Charity Card

I would like my donation to benefit children served by The Dyslexia Institute Centre  at: (Please tick as appropriate)
_________________________________ Card Number:___________________________
Please print your name and address below: Expiry Date: ________________
Title: ________________Initials: ______
Name: ___________________________ Signature: _____________________________
Address: _____________________________ Date: __________________
              _____________________________
              _____________________________ Please send the completed form to
Post Code: ________________ The Dyslexia Institute
FREEPOST SEA 3988
Telephone:  _______________________ EGHAM
TW20 0BR

No stamp is needed but using one will help to save us money.

Please make your cheque/PO payable (in UK Sterling) 
to either:

THE DYSLEXIA INSTITUTE or
THE DYSLEXIA INSTITUTE BURSARY FUND

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