Register your FUNDRAISING Thank you for choosing to support Neurocare. Please return your completed form via email to info@neurocare.org.uk or by post to Neurocare, Wycliffe House, Northern General Hospital, Herries Road, Sheffield, S5 7AT. After completing the form below, we ll add your details to our list of supporters so we can keep you up to date with how you are making a difference to neurosciences and neurology in Sheffield. This includes sending you our newsletter and information about our fundraising. Any personal details you provide are stored securely. We will never send your details to any third party. Your details Full name Date of birth Title Mr Mrs Miss Ms Other: Address Address 1: Address 2: Town: Postcode: Telephone* Email address* Social media details (optional) Your fundraising *Please note: by providing your mobile number and email address, you consent to receiving email communications and text communications, including fundraising messages from us. Facebook: Twitter: Instagram: Are you fundraising as part of a company/group? Yes No If yes, please provide your company/group name and details of who is in your team (continue overleaf if needed): What type of fundraising activity are you doing? Name of activity / event Date of activity / event Do you need a charity place? (Certain events only, minimum sponsorship applies) Taking part in an organised event eg. Great North Run Organising my own fundraising activity or event Yes, I need a charity place No, I already have my own place Fundraising Target Yes, my team needs number of places Would you like further advice to help you with your fundraising? Yes No How will the money you raise get to us? Why are you fundraising for Neurocare? Where did you hear about Neurocare? Online eg. JustGiving Offline eg. cash/cheque Both My JustGiving page is All offline money must be returned and clearly marked with your name. Please aim to return funds within 4-6 weeks after your event. Please turn over to sign our fundraising declaration
Declaration By signing or entering my name below, I understand and agree that I m undertaking a fundraising event or activity to raise funds for Neurocare, and so all proceeds of this event or activity are the monies of Neurocare and will be given to them at the earliest opportunity. I understand and agree that Neurocare does not accept any responsibility for this event or activity. I understand and agree that I am undertaking this event or activity at my own risk and that Neurocare is not responsible for any risk, injury, loss or damage that may result and will not be liable for any claim which may arise from this event or activity. Neurocare strongly recommends that if you are taking part in an event organised by a third party that you make sure that party has adaquate insurance, if you are using a venue that you get written permission from the venue confirming they are happy for you to use the venue for fundraising activities, that you check the venue has sufficient insurance to cover your event or activity and that you get a copy of the venue s Public Liability insurance. Signature Date THANK YOU FOR YOUR SUPPORT Neurocare Wycliffe House Northern General Hospital Herries Road Sheffield S5 7AT info@neurocare.org.uk 0114 226 9678 www.neurocare.org.uk Registered Charity No. 1169762 14
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SPONSORSHIP FORM Thank you for choosing to support Neurocare. Please send all sponsorship money along with any completed sponsorship forms to Neurocare, Wycliffe House, Northern General Hospital, Herries Road, Sheffield, S5 7AT. Title: Address Mr Mrs Miss Ms Other:.. Full name: Name of fundraising event: Postcode:... Date of fundraising event: If you pay UK tax and tick the box, the government will give us 25% on top of your donation it won t cost you a penny! Please fill in all details fully and tick the box below or we won t be able to claim on your donation. Declaration please read the following statement before ticking the box. is reclaimed by Neurocare from the tax you pay for the current tax year. Your address is needed to identify you as a current UK tax payer. By ticking the box you confirm that you want to the donation detailed below to Neurocare, given on the date shown. You confirm that you are a UK taxpayer and understand that if you pay less Income Tax and/or Capital Gains Tax than the amount of claimed on all your donations in that tax year it is your responsibility to pay any difference. Please notify Neurocare if you want to cancel this declaration, if you change your name and home address or you no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at a higher or additional rate, you must include all your donations on your Self- Assessment tax return for the additional relief due to you or ask HMRC to adjust your tax code. Please note that we cannot claim from a connected person; a wife, husband or civil partner, a brother, sister, parent or grandchild, a wife, husband or civil partner of a relative or a company under the control of the donor, or under control of connected persons. Full name Forename and surname we can t claim without both. Write one name only we can t claim for couples. Please write clearly Address A home address is required for. Please don t use a work address. Postcode Amount ( ) Date collected MR JOHN EXAMPLE 1 EXAMPLE STREET, ANYTOWN, ANYWHERE AB1 2CD 20.00 01.02.03 Further contact Please tick if you would like to hear from Neurocare by post so we can let you know how you can support neurosurgery and neurology patients in Sheffield this includes fundraising. Subtotal ( )
If you pay UK tax and tick the box, the government will give us 25% on top of your donation it won t cost you a penny! Please fill in all details fully and tick the box below or we won t be able to claim on your donation. Declaration please read the following statement before ticking the box. is reclaimed by Neurocare from the tax you pay for the current tax year. Your address is needed to identify you as a current UK tax payer. By ticking the box you confirm that you want to the donation detailed below to Neurocare, given on the date shown. You confirm that you are a UK taxpayer and understand that if you pay less Income Tax and/or Capital Gains Tax than the amount of claimed on all your donations in that tax year it is your responsibility to pay any difference. Please notify Neurocare if you want to cancel this declaration, if you change your name and home address or you no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at a higher or additional rate, you must include all your donations on your Self- Assessment tax return for the additional relief due to you or ask HMRC to adjust your tax code. Please note that we cannot claim from a connection person; a wife, husband or civil partner, a brother, sister, parent or grandchild, a wife, husband or civil partner of a relative or a company under the control of the donor, or under control of connected persons. Full name Forename and surname we can t claim without both. Write one name only we can t claim for couples. Please write clearly Address A home address is required for. Please don t use a work address. Postcode Amount ( ) Date collected MR JOHN EXAMPLE 1 EXAMPLE STREET, ANYTOWN, ANYWHERE AB1 2CD 20.00 01.02.03 Further contact Please tick if you would like to hear from Neurocare by post so we can let you know how you can support neurosurgery and neurology patients in Sheffield this includes fundraising. Subtotal brought forward from overleaf ( ) Subtotal this side ( ) GRAND TOTAL ( ) Please make all cheques payable to Neurocare **Charity use only** Date income paid to Neurocare. THANK YOU FOR YOUR SUPPORT Neurocare Wycliffe House Northern General Hospital Herries Road Sheffield S5 7AT info@neurocare.org.uk 0114 226 9678 www.neurocare.org.uk Neurocare is a registered UK charity. Registered Charity No. 1169762 14. Any personal details you provide are stored securely. We never sell your details to any third party. You can change your communication preferences at any point by emailing info@neurocare.org.uk or calling 0114 226 9678.