MEMBERSHIP APPLICATION FORM

If you would like to join The Caughley Society, please print this page in landscape format, complete in BLOCK CAPITALS and return to John Benbow, 10 School Lane, Wellington, Telford TF1 1JF, United Kingdom.

I/we wish to join The Caughley Society.

Annual subscription rate per household (please tick): UK £20 ___; overseas in sterling £25 ___; overseas in local currency £30 equivalent ____.

NAME(S): ..........................................................................................................................................

ADDRESS: .........................................................................................................................................

........................................................................................................................................................

.......................................................................................... POSTCODE/ZIPCODE: ...............................

TEL: .............................................. EMAIL: .......................................................................................

Payment can be made either by cheque made out to 'The Caughley Society' or by standing order. For the latter, please also complete the standing order form below.

If you are eligible, we would be most grateful if, in addition, you will complete the Gift Aid declaration below. This will allow us to claim back basic rate tax at no cost to yourself.

Please treat this and all future subscriptions and donations as being made under Gift Aid. For the year in question, I will pay as much UK income or capital gains tax as is being claimed back. I will notify the Society if my situation changes.


SIGNATURE: ................................................................................... DATE: .........................................

STANDING ORDER FORM

TO (name of your bank): ............................................................................. SORT CODE: ..... - ..... - .....

BANK ADDRESS: ..................................................................................................................................

........................................................................................................................................................

Please pay Lloyds TSB plc, 621 Mansfield Road, Sherwood, Nottingham NG5 2FY, sort code 30-97-55, for the credit of The Caughley Society, account number 01228353, the sum of £........ (in figures) .............................. pounds (in words) on ................................. 20........ (date) and thereafter annually on 2 January until further notice, and debit my account as follows:

ACCOUNT NAME: .................................................................... ACCOUNT NUMBER: .................................

SIGNATURE: ................................................................................ DATE: ............................................

Registered charity no 1137851