Please use this form to make a donationYou can donate online http://www.justgiving.com/powerlistfoundationYou may also TEXT to donate

Text PLID14 10 to 70070

Please make cheques payable to Powerlist Foundation and return this form with your gift to:Powerlist Foundation, c/o 10 Westbury Road, Penge, London, SE20 7QLThank you for Sharing Success with Tomorrows LeadersI would like to donate

Title (Mr/Mrs/Miss/Ms/Other)*

Name*

Home address*

Postcode*

Telephone number

Email address

* Fields marked with an asterisk must be completed

Please let us know if your circumstances or address details change so that we can amend our records.

Make your gift worth even more, without costing you a penny.

Do you pay tax? If so, by simply completing this form the tax office will give us 25p for every 1 you donate.

I am a UK tax payer and I would like the Powerlist Foundation to treat all donations I have made for the four years prior to this year and all donations I make in the future as Gift Aid donations until I

notify you otherwise. I understand that I must have paid an amount of income tax and/or capital gains tax for each tax year

(6 April one year to 5 April the next) that is at least equal to the amount of tax that Powerlist Foundation claims on my donations for that tax year.

Full name

Date

One off/two years/three years/until further notice

Powerlist Foundation, registered charity in England and Wales (1138699)

A company limited by guarantee. Registered company in England and Wales (7082850).

Registered office: Powerlist Foundation, c/o Powerful Media Ltd 2nd Floor, Cumbrian House, 217 Marsh Wall, London E14 9FJ