Justice Reflections - Application Form

	Justice Reflections Application Form Worldwide Papers Linking Christian Ideas with Matters of Justice	When complete please print out, sign and date these forms and send them to: Justice Reflections 2 Temple Gardens Lincoln LN2 1NP United Kingdom or by SECURE FAX to: +44 (0) 1522 856824

Your Details
Title:		Forename(s):		Surname:
Address:				ZIP/ Postcode:
Telephone number:			Fax number:
Email address:

(please tick the boxes below which apply)
I am unable to pay but would like to receive "Justice Reflections".	No Yes
I am a UK Taxpayer and am willing to make my donation subject to Gift Aid. (Please complete and return the Gift Aid Declaration)	No Yes
I undertake to confirm my application annually.	No Yes

Annual Standing Order (UK Banks only)
If you wish to pay by Standing Order, please specify the amount you wish to pay

Donation
I would like to make an annual donation of:	£
	Currency/amount

I wish to pay by: (please check a 'radio' button on the right)
Cheque (in £GBP drawn on UK Bank). I enclose cheque payable to "Justice Reflections"
Annual Standing Order - please complete the Standing Order Form
VISA/MasterCard - please complete the box below

Credit Card Details
Credit Card:			An Annual Donation:
Card Number:
Card Expiry Date:	Month		Year
Name on card:
Card Holder's Registered Address:

Signature	Date