How do I sign up'

Please fill in the attachedform and return to

Jane Chapman

FIFE 2005

NCH, the children's charity

85 Highbury Park

London

N5 1UD

Tel: 020 7288 7837

Fax: 020 7226 2537

Jane.chapman@nch.org.uk

FILM INDUSTRY FOOTBALL EVENT 2004

FULHAM FOOTBALL CLUB CRAVEN COTTAGE

SUNDAY 5TH JUNE 2005

ENTRY FORM

Please enter my team at £1,000. I understand that teams will besold on a first come first served basis.

Entry price includes:-

' entry to the five asidetournament at Fulham Football Club

' 10 free spectator tickets.

Please also book me:-

______ additional spectator tickets at £5 per person (alsoavailable on the day for team guests)

I/we cannot enter a team but wish to make a donation*

I enclose a cheque for the full amount of £___________, madepayable to NCH

or

I wish to pay by: Mastercard / Visa / Switch / American ExressCard to the amount of £__________

Card Number

Authorisation digits (last 3 digits from the signature strip onreverse of card)

Expiry Date: ______________ Today's Date: ______________

Name (as it appears on card):_____________________________________

Signature: _____________________________________

Team Contact Name: _____________________________________

Address: _____________________________________

_____________________________________

__________________ Postcode:__________

Daytime Tel Number: _____________________________________

Email Address: _____________________________________

All enquiries, please, to Jane Chapman at NCH on 020 7288 7837 or jane.chapman@nch.org.uk

Please tick the option below and add today's date to make your gift worth 28% more at no extra cost to you

* I am aUK taxpayer and I want NCH to treat all donations from 6th April 2000, until I notify you otherwise, as Gift Aid donations. I am currently paying income tax and capital gains tax that is equal to or more than the tax that NCH reclaims (currently 28p in every £1 you give) in the tax year.

Date.............

You can cancel this declaration at anytime by notifying NCH.