Justice Reflections

Justice Reflections
Application Form

Worldwide Papers
Linking Christian Ideas with Matters of Justice

For further information
Telephone: +44 (0)1522 682357
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 684866
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:

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