|
Patron:
Edwina Currie |
Chair:
Derek Butler
|
President:
Professor Hugh Pennington |
MRSA ACTION UK
Raising Public Awareness – Campaigning for Safer Standards
Supporting Victims & Dependants
Registered Charity No. 1115672
You can help just by giving an annual subscription of £10, or you may wish to help by distributing leaflets, or in some other way. We are all volunteers helping to raise awareness and provide support to those affected by healthcare infections, join us today.
Give a form to a friend in Microsoft Word format or in PDF format
Membership Form
The information provided will be treated in the strictest confidence.
First name _____________________ Surname __________________________________
Address _________________________________________________________________
______________________________ Postcode __________________________
Male. / Female I would describe my ethnic origin as ______________________________
Do you consider yourself (or your loved one) to have a limiting disability?
Yes ________ No________
If yes, do you consider the disability is as a result of acquiring an infection in hospital?
Yes ________ No________
Phone (Home) __________________________ Business. ___________________________
Mobile ________________________________ Email ______________________________
My Membership Contribution: £ 10.00
My Donation (optional): £ ______________
Total Amount: £ _____________________
I enclose my cheque/crossed postal order made payable to MRSA Action UK.
Please do not send cash through the post.
SIGNED. _________________________________________ DATE __________________
PLEASE SEND TO:
Mrs Mavis Law, Treasurer, MRSA Action UK,
9 Beckenham Grove, Winsford, Cheshire CW7 2YD
Your Annual Membership entitles you to 10 Newsletters per year, our patient leaflets, and all the help and support you need
If you would like to become more involved in the work of the Charity we always welcome the opportunity for members to take part or to become representatives.
________________________________________________________________
Using Gift Aid means that for every pound you give, we get an extra 28 pence from the Inland Revenue, helping your donation go further.
This means that £10 can be turned into £12.80 just so long as donations are made through Gift Aid. Imagine what a difference that could make, and it doesn’t cost you a thing.
So if you want your donation to go further, Gift Aid it. Just complete this form and send it back to us.
I want the charity MRSA Action UK to treat the enclosed donation of
£____________ as a Gift Aid donation
My details are:
First name ________________________ Surname _______________________
Address ________________________________________________________
______________________________ Postcode __________________
I am a UK Tax payer, signature _____________________________________
I would like to Gift Aid all donations I’ve made MRSA Action UK since 6 April 2000 and all donations in the future to be Gift Aid until I notify you otherwise.
To qualify for Gift Aid, what you pay in income tax or capital gains tax must at least equal the amount we will claim in the tax year.
MRSA Action UK
Registered Charity No. 1115672
Please return to Mrs Mavis Law, Treasurer, 9 Beckenham Grove, Winsford, Cheshire, CW7 2YD