ICGN Scholarships: Donation Form
We welcome donations to the ICGN Scholarship programme which helps individuals from developing markets join our work
programme over a three year period. Since 2007, 56 individuals from 37 countries have benefited from a scholarship bursary to
help support their efforts in promoting good governance reform locally. We provide two programmes in memory of Sir Adrian
Cadbury and Alastair Ross Goobey in recognition of their respective contributions to corporate governance reform world-wide.
Please return the completed form:
By email:
By post:
To Marlice Johnson at marlice.johnson@icgn.org
To ICGN Scholarships, ICGN, Saffron House, 6 -10 Kirby Street, London, EC1N 8TS, UK
Please complete the following details:
Title
First Name
Surname
Building Name/Number
Address 2
Postcode
City
Country
Telephone
Email
Yes, I/We would like to donate:
☐ £50
☐ £100
☐ £150
☐ Other
Payment Method
☐ I enclose a cheque (Please make cheques payable to ICGN and include the donation form when posting)
☐ Please charge my credit/debit card (insert card information below)
☐ Visa ☐ MasterCard ☐ American Express ☐ Other (Please Confirm) ……………………………….....
Card Number
Valid From
Security Code
Signature
/
Expiry Date
/
Issue Number (if necessary)
Date
For further information please contact: Marlice Johnson Email: marlice.johnson@icgn.org. Telephone: +44 (0) 20 7612 7084