MEMBERSHIP APPLICATION FORM

If you wish to join/renew the society, please complete this form

Name ………………………………………………………. Address ……………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………Postcode…………………………………

Tel. Landline……………………………. Tel. Mobile……………………………………………..

Email ……………………………………………………………………………………………………………… MEMBERSHIP NO……………………..

I agree to abide by the constitution and the rules of the Society. I enclose a cheque made payable to the Daniel Adamson Preservation Society for £25.00 (Single Membership) or £30.00 (Family Membership)

Signed …………………………………………….. Date …………………………………..

STANDING ORDER MANDATE

To……………………………………………………………………………. NAME OF BANK -

Please pay the following annual subscription till further notice. PLEASE DEBIT MY ACCOUNT BELOW

Account Name (Capitals) / Account No. / Sort Code
Payee / Sort Code / Account No. / Membership No.
Daniel Adamson Preservation Society / 20-78-42 / 70953040
Amount in Words / Amount
£
Date of First Payment / Frequency / And Thereafter
1st May / Annually
Signature / Date

Gift Aid Declaration – for past, present & future donations

Please complete Gift Aid Form to maximise your subscription Daniel Adamson Preservation Society

Please treat as Gift Aid donations all qualifying gifts of money made

Title ………………… First Name or initial (s) ………………………………………………….. Surname……………………………………………………..Address…………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………………………………

Postcode ……………………… Date……………………………… Signature ……………………………………………………………………………………..

Please complete & Return to: - Sheila Leonard, 60 Halton Road, Runcorn, Cheshire, WA7 5SB

or email form to

To enable us to claim Please notify the charity of CASC if you

I confirm I have paid or will pay an amount of Income Tax and/or * Want to cancel this declaration

Capital Gains Tax for each tax year (6 April to 5 April) that is at least * Change your name or home address

equal to the amount of tax that all the charities or Community Amateur * No longer pay sufficient tax on your income and/or capital gains

Sports Clubs (CASCs) 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 If you pay Income Tax at the higher or additional rate and want to

not qualify. I understand the charity will re-claim 25p of tax on every receive the additional tax relief due to you, you must include all your

£1 that I give. Gift Aid donations on your Self-Assessment tax Return or ask

HM Revenue and Customs to adjust your tax code.