Direct Debit

Your donation can help save and change children's lives

* All fields marked with an asterisk must be completed
Donation options
I wish to give £ a month *

Gift Aid your donation

If you are a UK taxpayer, the value of your donation can increase by 25% under the Gift Aid scheme at no extra cost to you.

* I confirm that I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the tax that all of the charities or Community Amateur Sports Clubs that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. The charity will reclaim 25p of tax on every £1 that I have given

Please notify us if you change your name or home address, or if you no longer pay sufficient tax on your income and/or capital gains.

Name and address
By providing your phone number, you are giving Action Medical Research permission to contact you by phone
Bank or Building Society details

In order to set up a Direct Debit instruction online, you must be the account holder of a personal bank or building society account. If you are NOT the only required signatory on your account you can download the printable PDF version of the Direct Debit form here.

View the Direct Debit Guarantee

Keeping you informed

We would like to keep you up to date with Action news by email as this is a cost effective way for us to keep supporters informed about our work.

You can stop receiving emails at any time by selecting unsubscribe in the email.

The charity will hold the information you give us for communication, marketing and administration purposes in accordance with the Data Protection Act 1998. If you do not wish to receive news or appeals from the charity in the future please call Supporter Care on 01403 210406 or email

What prompted you to make a donation

By clicking 'Complete >' I confirm that I am the sole named account holder for the above and am happy for Action Medical Research to set up the Direct Debit Instruction.

Secure Payment

We want to reassure you that by working with the best partners like Thawte we'll keep your data safe.

Contact Us

If you have any question about giving a donation please give us a call on 01403 210406

Other ways to pay

Telephone 01403 210406

Post Download Form

Action Medical Research is a member of the Fundraising Standards Board

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