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Trader ID *
Trader Name *
Email Address *
Charity Name *
Registered Charity Number *
Charity Contact Name *
Charity Website *
Charity Email Address *
Address of Charity *
County Area for the Charity *	Please select Bedfordshire Berkshire Bristol Buckinghamshire Cambridgeshire Cheshire City of London Cornwall Cumbria Derbyshire Devon Dorset Durham East Riding of Yorkshire East Sussex Essex Gloucestershire Greater London Greater Manchester Hampshire Herefordshire Hertfordshire Isle of Wight Kent Lancashire Leicestershire Lincolnshire Merseyside Norfolk North Yorkshire Northamptonshire Northumberland Nottinghamshire Oxfordshire Rutland Shropshire Somerset South Yorkshire Staffordshire Suffolk Surrey Tyne and Wear Warwickshire West Midlands West Sussex West Yorkshire Wiltshire Worcestershire Anglesey Brecknockshire Caernarfonshire Carmarthenshire Cardiganshire Denbighshire Flintshire Glamorgan Merioneth Monmouthshire Montgomeryshire Pembrokeshire Radnorshire Aberdeenshire Angus Argyllshire Ayrshire Banffshire Berwickshire Buteshire Cromartyshire Caithness Clackmannanshire Dumfriesshire Dunbartonshire East Lothian Fife Inverness-shire Kincardineshire Kinross Kirkcudbrightshire Lanarkshire Midlothian Morayshire Nairnshire Orkney Peeblesshire Perthshire Renfrewshire Ross-shire Roxburghshire Selkirkshire Shetland Stirlingshire Sutherland West Lothian Wigtownshire Antrim Armagh Down Fermanagh Londonderry Tyrone Please select Special Needs School Pre-School/Nursery Primary School Sports School Children’s Hospice Adult Hospice Disease & Disorder Medical Services and Treatment Medical Research Patient and Family Support Recreational Scouts etc. Environmental Arts & Culture Other
If 'Other' Please categorise
Charity Mission Statement * (Please cut and paste from website)
Use of funds *
Please outline previous or current fundraising you have undertaken with your nominated charity, providing dates and amounts raised. *

Security test. Please identify the pictures:*
Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree	Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree	Click to identify Apple Cat Clock Dog Flower Fork Hammer Key Ship Tree

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