Sponsor formEvent: Loaghtan Loaded - Longest Day, Longest Ride 2011

Date: 18th and 19th June 2011

Target

Name

Address

Postcode

Contact number

Thank you

For more information about the Muscular Dystrophy Campaign call 020 7803 4800 or visit www.muscular-dystrophy.org

Leading the fight against muscle disease

www.llldlr11.com

Initial Surname Home address (We need this, and your postcode to claim Gift Aid)

Post code Amount pledged

Amount received

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Total raised £

For official use only – amount to Gift Aid £

Sponsor formDon’t forget to tick the gift aid box. It doesn’t cost you any extra but allowsthe Muscular Dystrophy Campaign to reclaim the tax on your donation.

Registered Charity No. 205395 and Registered Scottish Charity No. SC039445

Initial Surname Home address (We need this, and your postcode to claim Gift Aid)

Post code Amount pledged

Amount received

Tick here for

Total raised £

For official use only – amount to Gift Aid £

Registered Charity No. 205395 and Registered Scottish Charity No. SC039445

For further information about muscle disease and theMuscular Dystrophy Campaign call 020 7803 4800email info@muscular-dystrophy.orgor visit www.muscular-dystrophy.org

Registered Charity No. 205395 and Registered Scottish Charity No. SC039445

How to send your money to usPlease do not send cash. Send cheques made payable to ‘Muscular Dystrophy Campaign’ along with all your sponsor forms to the address opposite.

Office use only:

Date banked:

Income code for claim:

Gift Aid amount:

Gift Aid input:

If you Gift Aid your donation,we will continue to receive an additional 28p. We can claim Gift Aid tax relief of 25p on every pound you give and HMRC will also be operating transitional provisions for Gift Aid donations made from 6 April 2008 until 5 April 2011, paying a Government supplement of 3p on every pound you give. To qualify for Gift Aid, what you pay in income tax or capital gains tax must at least equal the amount that the charity will reclaim on the donation.

“ Running the marathon was the most amazing experience I have ever had and I wanted to thank you all for the support you gave me. Without your help I don’t think I would have finished. Raising the money for the Muscular Dystrophy Campaign was a total pleasure.” Dave Cullen, Leicester

“ I would love to run for Muscular Dystrophy Campaign again – it’s a cause very close to mine and my family’s hearts.” Lisa Laguarda

About muscular dystrophyMuscle disease causes muscles to waste and weaken making it hard for those affected to do even the simplest task. It doesn’t just affect the muscles in the arms and legs but the heart and respiratory muscles too. Mobility is affected and most conditions lead to some sort of disability. More than 70,000 babies, children and adults in the UK are affected.

Muscle disease is life-limiting. There are no cures.

What does the Muscular Dystrophy Campaign do? We provide free practical and emotional support.

We fund world-class research to find effective treatments and cures.

We campaign to raise awareness and bring about change.

We give grants towards the cost of specialist equipment, such as powered wheelchairs.

We lead the fight against muscle disease – together we’re stronger.

Muscular Dystrophy Campaign office:

Volunteer FundraisingMuscular Dystrophy Campaign 61 Southwark Street London SE1 0HL