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BORN SURVIVOR 2017

Date: 9th September
Details: Born Survivor's not your average trail run or obstacle event. It's designed
to be tough and testing and it may just break you. West House Warriors is a team
made of our toughest, strongest staff and supporters who will be taking part in
BORN SURVIVOR to raise funds for West Cumbria's leading provider of care and
support to those with learning disabilities.

Name: __________________________________________________

Email____________________________________________________

West House is a registered charity (Registered Charity No 28282R) & so Gift Aid can also be claimed.
Using Gift Aid means that for every pound given, your charity will receive an extra 28p from the Inland Revenue,
helping each donation go further at no cost to the donor.
DECLARATION: We, who have given our names and addresses below and who have ticked the box entitled ‘Gift
Aid ()’, want Charities Trust to reclaim tax on the donation detailed below. We understand that each of us must
pay income tax or capital gains tax equal to the tax reclaimed by the charity on the donation.

Amount Amount
* Full Name * Home Address * Postcode * Gift Aid pledged paid
()
John Example 1 Example Avenue, Liverpool L1A 2LL  £5.00 £5.00

If you would like to pay by cheque, please make it payable to: West House
Thank you for your generous support!