Friends of Headway membership form

Use the form below to purchase your Friends of Headway membership. Special rate annual membership applies for brain injury survivors, carers and students.



Who are you buying this membership for?





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Further contact - please tick yes!
We would like to keep in touch with you to ensure you’re up-to-date with news, developments and fundraising from Headway. We won’t bombard you with information and we promise to never share your details with third parties for marketing purposes.

Please indicate how you would like to hear from us in addition to the benefits you will receive as part of your membership:



Press the 'submit' button to pay for your membership by credit or debit card...

Payment


£
Gift Aid

Gift Aid will increase the value of your donation by 25% at no extra cost to you. You must pay an amount of Income or Capital Gains Tax equal to your total donations each year.

"I confirm I am a UK income or Capital Gains taxpayer. I have read this statement and want Headway - the brain injury association to reclaim tax on the donation above, made on the date of this declaration. I understand that if I pay less Income Tax/or Capital Gains Tax in the current tax year than  the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given."
Your gift will help us to continue our work to improve life after brain injury.

Please enter your credit/debit card details below and click 'Submit' to process your payment.
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Review your order

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Click 'Submit' to process your payment. When complete, you will be taken to the confirmation screen on the Headway website.