Much Dewchurch Society

Application for Membership

                                                        Full name(s)  1…………………………………………………………………………………

                                                                               2…………………………………………………………………………………

                                                                               3…………………………………………………………………………………

                                                        Address       ……………………………………………………………………………………

                                                                               ……………………………………………………………………………………

                                                        Post Code     …………………………Telephone………………………………………

                                                        Email           ……………………………………………………………………………………

                                                        Preferred method of contact……………………………………………………..

                                                        Membership : Life/Full/Family/Other………………………………………

                                                        I apply for membership of Much Dewchurch Society and I agree to be bound by its rules.

                                                        I agree to the above details being held on the database of the Society to enable communication with me

                                                        in my capacity as a member.

                                                        Signature     ……………………………………………………………………………………

                                                        Date            ……………………………………………………………………………………

                                                        Subscription of £……………………………………………..…..Paid Yes – No

                                                        Donation of £…………………………………………………………..……..enclosed

                                                                                                Charity Number 1120826

                                                                                                GIFT AID DECLARATION

                                                                            I the above named ……………………………………………………………….want the Society to treat all donations

                                                                            I make from the date of this Declaration (until I notify you otherwise) as Gift Aid donations.

                                                         I note that I must pay an amount of income tax and/or capital gains tax at least equal to the tax that the

                                                        charity reclaims on my donation in the tax year (currently 28p for every £1 I give)

                                                                            Signature           …………………………………………………………………………………………………………………

                                                                            Charity Reference Number……………………………………………………………………………………………….