Donation Request

Please complete the form below if you would like to be considered for a donation from the Birchington Together CIC lottery profits.

Name *

First

Last

Email *

What group or good cause would you like the donation? for *

Donation required *50100250Another amount

Another amount *

Brief description of what the donation will be used for *

If any donation will be used to purchase or part purchase equipment, please give details of the supplier, or a link to the supplier

Does your group have a bank account? *

• Yes
• No

if you don’t have a bank account we cannot transfer you the money but we can purchase the items for you

GDPR Agreement *

• I consent to having this website store my submitted information so they can respond to my request.

Publicity Agreement *

• Confirm that you agree to Birchington Together CIC publicising the donation on their Website, Facebook page and Newsletter

Submit