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* 1. First name

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* 2. Surname

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* 3. These are my intentions regarding leaving a gift to Back Up in my will

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* 4. Please use this box to give your additional thoughts and feedback on leaving gifts in your will.

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* 5. Email address

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* 6. Address

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* 7. Phone number

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* 8. We would like to contact you with information about our services and how you can support us, including ways to volunteer, take part in research, how you can donate to us and get involved in our fundraising activities and events. We promise to always keep your details safe and we will never share your details with any third party. (unless we feel you are at risk - as outlined in our safeguarding policy)

Yes, please contact me by (please tick)

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