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.

Annual subscription rate per household (please tick): UK £20 __; overseas in sterling £25 __; overseas in local currency £30 equivalent __. If you are overseas and wish to pay by PayPal, please scroll down and use the Buy Now button if you wish to pay for one year only, or the Subscribe button if you want to pay on a continuing basis.

I/we wish to join The Caughley Society.

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

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

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

TEL: .............................................. EMAIL*: ......................................................................................
*By providing your email address, you agree to receive information from the Society by email. We will not pass on any of your details to any other organisation.

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. I confirm that I have paid, or will pay, an amount of income tax and/or capital gains tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or community amateur sports clubs that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and council tax do not qualify. I understand that The Caughley Society will reclaim 25p of tax on every £1.00 that I give. I will notify the Society if I wish to cancel this declaration, change my name or home address, or no longer pay sufficient tax on my income and/or capital gains.


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

STANDING ORDER FORM

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

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

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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