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Full Name First line of your address Postcode Amount Date

Pledged Collected



















PSP and CBD:
Affect 15,000 people in the UK
Are terminal diseases; life expectancy is
between 5 and 8 years
Leaves those affected unable to walk, talk,
eat or see.
The PSP Association:
Provides help and support for those living
with PSP and CBD
Funds research into the cause, treatments
and eventually a cure for PSP
Relies on voluntary donations.
Thank you for your support PLEASE MAKE ALL CHEQUES PAYABLE TO THE PSP ASSOCIATION
Make your donation go further at no extra cost to you!
Under the governments Gift Aid scheme, all donations made by UK
tax payers are worth approximately 25% more (i.e. for every 1 you
donate, we can reclaim 25p) Simply tick the Gift Aid box if you
pay tax in the UK.
The PSP Association
PSP House, 167 Watling Street West,
Towcester, Northants NN12 6BX
Tel: 01327 322410 Fax: 01327 322412
Email: psp@pspassociation.org.uk
Website: www.pspassociation.org.uk
Gift
Aid
MRS ANN SAMPLE 12 SAMPLE ROAD AB1 12CD 4 10 01/03/14
Sponsor Form
Please help
Name:_____________________________________________________
Address: ___________________________________________________
__________________________________________________________
___________________________________ Postcode _______________
To raise money for people affected by PSP by:
______________________________________ Date: ______________
Working for a world free of PSP & CBD
Royal Patron: HRH The Duchess of Gloucester, GCVO Founder and Life President: Brigadier Michael R Koe, OBE
President: General the Lord Guthrie of Craigiebank GCB,LVO, OBE Vice-Presidents: The Lord Coe KBE, Sir Michael Carleton-Smith CBE DL, Professor Colin Blakemore FRS
Chairman: Mr Christopher R M Kemball Chief Executive: Mr Fergus Logan Hon Treasurer: Mr Peter Glithero FCA
The PSP Association is a Company limited by guarantee. Registered number: 2920581 Registered Charity numbers: England and Wales 1037087 / Scotland SC041199
Registered Office: PSP House, 167 Watling Street West, Towcester, Northamptonshire NN12 6BX
Full Name First line of your address Postcode Amount Date
Pledged Collected


































Gift
Aid

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