Merchandise Order Form

To support you with your awareness raising and fundraising, PKD Charity is able to offer you the following items free of charge. Please use the blank fields provided to specify how many of each item you would like us to send.

PKD Charity T-shirt

PKD Charity Running Vest

Collection Tin

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Collection Bucket

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General Information Leaflet

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Collection Envelope

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Small Collection Box

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Your details will only be used by the PKD Charity to send you information about our work and fundraising appeals. You can ask us to remove you from our database at any time and we will never give your information to other organisations. Please tell us if you are happy for us to contact you:

Name*

Please enter your name!

Email*

Please enter your email address!

Phone

Please enter you phone number!

Address Line 1*

Please enter building number or name!

Address Line 2

Address Line 3

City / Town*

Please enter your city / town!

County / State*

Please enter your county or state!

Country

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Postcode*

Please enter your postcode!

Event Name

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Event Date

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Keep in touch

By telephone

By post

By SMS

By email

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Merchandise Order Form

PKD Charity is a Member of