Exit this survey Friends of Grand Union 1. Default Section To become a Friend of Grand Union, please complete the form below. If you require any assistance to complete your form, call the office on 0208 981 1551 or email supportus@grandunion.org.uk w 0 Question Title * 1. Full name: w 0 Question Title * 2. Contact Telephone number(s) w 0 Question Title * 3. Contact Address and Postcode w 0 Question Title * 4. Email Address w 0 Question Title * 5. What kind of donation would you like to make? w 0 £5 per month £10 per month £20 per month If you would like to discuss a different amount or a one off donation, please check this box Question Title * 6. If you are a UK Tax Payer you can allow Grand Union to claim back the tax paid on the money you give us, increasing your donation by almost a quarter with no extra cost to you. w 0 I am a UK tax payer and would like GUO to reclaim tax on my donations and all donations from the date of this declaration until I notify otherwise. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for the current tax year. I am NOT a UK tax payer Question Title * 7. Would you like your email address to be added to our regular mailing list? w 0 Yes No Question Title * 8. How did you hear about becoming a Friend of Grand Union? w 0 At a concert On our monthly newsletter Website Social Media Other (please specify) Thank you for completing your form to become an Friend of Grand Union. Before you finish, please confirm and date your online form. Once you submit the form you will be contacted by a member of our team. w 0 Question Title * 9. Please tick this box to confirm the details within this form are correct and that you are happy for Grand Union to use this information for the purposes of the Friend of Grand Union scheme. By ticking this box you also confirm that Grand Union can contact you about finalising your payment to the scheme. w 0 I confirm the information I gave is correct and that Grand Union can contact me. Question Title * 10. Date (DD/MM/YY) w 0 Done