United Kingdom Acquired Brain Injury Forum

Donations - Secure Online Donation Form

Please leave the area code box empty for the phone numbers of both donation and billing information sections of this form. This is due to the form working to US configuration which does not apply to UK formats - thank you!

Campaign/Fund Information
Campaign/Fund *	The General Fund

Donation Information
Donation Amount *	£
Payment Method *	Credit Card
Donation Type *	One-Time Donation Recurring Monthly Donation (until cancelled) Split this Donation into Monthly Payments
Number of Payments *
Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	/
Organization
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Billing Phone *

Terms Of Use
Refunds, returns and cancellation information Event Cancellation policy: Cancellations must be made in writing. Refunds are available if cancellations are received before 6 weeks before the event minus £30 processing fee, no refunds can be given after this date. You may nominate a substitute attendee at any time.
I Accept the Terms of Use

The Cardholder stated above has authorized this payment. If this payment is part of a recurring series of payments, the Cardholder understands the terms and amounts of those recurring payments, and authorizes payment for each of them. Cardholder consent will expire once all scheduled recurring payments have been processed, or if all future recurrences are cancelled. The Cardholder acknowledges that specific payment dates may vary. Examples include, but are not limited to: payment dates falling during weekends, holidays, or during system outages. In order to facilitate the processing of those recurring payments, stored credentials will be used. Those stored credentials will only be used to process payments that are part of this series of recurrences. In order to use those stored credentials for any other payment, Cardholder re-authorization will be required. In the event that a consent agreement must be modified, the new agreement will be sent to the email address associated with the invoice.

The Cardholder understands the terms and authorizes the payment(s).

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