Penty Noweth Farm, Trenoweth Lane, Mabe Burnthouse,

PENRYN, Cornwall TR10 9JB

TEL. 01326 373601 Reg Charity 1153858

Membership Application Form

I/we would like to be a member of The Flicka Foundation and to contribute to all the rescued, re-homed and elderly horses, ponies, donkeys and other animals – to help them live out the rest of their days in peaceful retirement.

An adoption is a minimum of £25 for the year or £3 a month standing order (which saves us alot of admin)! Your adoption pack will include a glossy folder, welcome letter, certificate, (with a picture of your chosen horse or donkey) a glossy photo, some information about 'Flicka', a brief history of your horse or donkey, the latest newsletter, a car sticker, wristband, pen, fridge magnet and your unique member card..

PLEASE REMEMBER IF YOU CAN DO A MONTHLY STANDING ORDER – FOR AS LITTLE AS £3 PER MONTH – IT SAVES THE CHARITY A LOT OF ADMINISTRATION COSTS. THANK YOU!

Chosen horse/pony/donkey______

I enclose cheque/PO/cash______(Amount)

I am a UK tax payer and wish to ‘Gift Aid’ my donation YES/NO ______

I have completed the Standing Order Form, which is to commence on______

(Date)

And thereafter on the same day each month for the amount of______

Please Print Clearly; Name______

Full Postal Address______

Post Code______Tel No______

Email______

Date______Signed______

Welcome to our ‘exclusive’ team of adopters and thank you from The Flicka Foundation.

Penty Noweth Farm, Trenoweth Lane, Mabe Burnthouse, PENRYN, Cornwall

TR10 9JB TEL. 01326 373601 reg charity 1119492

For a Standing Order – Of a minimum of £3.00 per month you can ‘Adopt’ a horse or donkey. You will receive three newsletters per year and/or any supplementary appeals or invitations, a colour photo of your favourite horse/donkey and a membership card, a ‘Flicka’ pen and certificate.

I/We would like to begin a monthly Standing Order;

Made Payable to: The Flicka Foundation Account Number: 63344234

Bank Name: Santander Sort Code: 09-01-28

Bank Address: Bridle Road, Bootle L30 4GB

Received from: (Your bank details)

Account______Account No______(Please print clearly the name which is on your account)

Sort Code:______

Bank Name & Address:______

Post Code______

Account holders address______

______Post Code______

I/We would like to pay by Standing Order to ‘The Flicka Foundation’ the sum of ;-

Amount in words______Amount in figures______

On the ______(date) and on the same day of each month thereafter.

Your signature______Date______

Please Print Your Name______

Please forward both pages to The Flicka Foundation….many thanks.