Maggie’s Christmas Carol Concert

St Paul’s Cathedral, 16 December 2014

Early ticket sales booking form

Concert only

I would like □ concert tickets at £150 each (seated in the Dome)

I would like □ concert tickets at £100 each (seated in the Dome)

For a full seating plan of St Paul’s and other tickets available from £25 please visit www.maggiescentres.org/st-pauls

Gold tickets: Concert, champagne reception and dinner

I would like □ concert and dinner tickets at £1,000 each (concert tickets will be seated in the Dome)

The cost of a gold ticket is £350 and the full ticket price includes an optional donation of £650 to Maggie’s.

I would like □ concert and dinner tables at £10,000 each (concert tickets will be seated in the Dome)

One table seats 10 guests. The cost of a gold table is £3,500 and the full ticket price includes an optional donation of £6,500 to Maggie’s.

Please note gold tickets are issued on a first come, first serve basis subject to availability and are only confirmed once payment is received.

Your details

Title First name Surname

Company name (if applicable)

Address

Postcode

Email Telephone

Committee member

Make your gift worth 25% more with Gift Aid

If you are a UK taxpayer, make your donation worth a quarter more at no extra cost to you - just by ticking a box. We can reclaim and extra 25p as Gift Aid for every £1 you donate.

Yes, I am a UK taxpayer and I would like Maggie’s to reclaim the tax on all qualifying donations from the last 4 years as well as any future donations until I notify you otherwise. I understand that I must have paid income / capital gains tax that is at least equal to the amount of tax that all the charities and CASCs I donate to will reclaim on my Gift Aid donations in the tax year which they are received and the council tax and VAT do not count for this purpose.

No, I am not a UK taxpayer or do not pay sufficient tax for you to claim Gift Aid on my donations.

I confirm that I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April – 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.

Date of Declaration / /

Payment details

Total amount payable

I enclose a cheque payable to ‘Maggie’s Centres’

Please invoice me at the above address

Credit/debit card payment: Visa / MasterCard / AmEx / Switch (please circle)

Card number / / /

Exp date / Issue number or Start date / Security number

Name on card Date

How would you like us to keep in touch with news and updates about Maggie’s?

I’m happy to receive information by email

I’m happy to receive information by SMS

Maggie Keswick Jencks Cancer Caring Trust (Maggie’s) is a registered charity, No. SC024414

I do not want to receive information by post

I do not want to be contacted by telephone

All proceeds will go towards growing Maggie’s Centres in London. For more information please visit www.maggiescentres.org

Please return all completed forms to:Rebecca Lyle, Maggie’s Centres, 2nd Floor, Palace Wharf, Rainville Road, London, W6 9HN or via email to rebecca.lyle@maggiescentres.org. If you have any queries please call 020 7386 3556.