Tick here if you would like to receive an acknowledgement of your donation
Tick here if you would like to receive more information about stammering and Dom's Fund.
Tick here if you would like to help raise more funds for Dom's Fund..

(Note: Charitable causes can reclaim tax already paid on donations made under the Gift Aid scheme. The giver must have paid a tax amount that at least equals the tax being reclaimed on the donation. UK tax paid on income, capital gains and savings all qualify.
If you are a UK taxpayer, please use the Gift Aid declaration form to enable us reclaim tax.)

Please make cheques payable to: The Dominic Barker Trust.

When completed and signed please return this form to:
The Dominic Barker Trust, Pound Close, Holbrook, Ipswich, Suffolk IP9 2RA.