Pertemps Champions Willberry Charity Derby
Epsom Racecourse 27th August 2018

Ticket Application Form

Please remember that the fields below which are marked with a  *  are required fields.

Please send me  Pertemps Champions Willberry Charity Derby Day Lunch tickets @ £125.00 per person which includes entry to the racecourse. Tables of 10 are available.*



If you are supporting a particular jockey please let us know for table and seating plan purposes:

Horseshoe Donation

All donations will be printed in the programme on our special Horseshoe Donation page. Please indicate which Horseshoe you would like by ticking the box and how you would like your name to appear in the programme, in the field opposite.

GOLD HORSESHOE       £200  
SILVER HORSESHOE     £100   
BRONZE HORSESHOE   £50  

I would like to support the Pertemps Champions Willberry Charity Race Day further by making a donation / I am unable to attend and would like to make a donation of £ †

† I would like The Bob Champion Cancer Trust / Hannah's Willberry Wonder Pony to benefit by reclaiming the Gift Aid on this and all future donations. Please complete the address details above.
Signature 
 Date 

NOTES:
1. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that The Bob Champion Cancer Trust reclaims on your donations in the tax year.
2. If you claim tax at a higher rate you can claim further tax relief in your Self Assessment Tax Return.

Summary:

Cost of Lunch Tickets£
Horseshoe Donation£
Donation †£
TOTAL£
 

You can alternatively send or phone your order to:
Lucy Wilkinson | Tel 0207 924 3553 | Mobile 07973133685 | lucy@bobchampion.org.uk

Pertemps Champions Willberry Derby,
6 Salcombe Gardens,
57 Clapham Common Northside,
London SW4 9RY


The Bob Champion Cancer Trust

Reg. charity no. 1024664

Hannah's Willberry Wonder Pony Charity

Reg. charity no. 1166416