Victoria Baths

Friends Membership /

Volunteer Application Form2016

Title Mr/Mrs/Miss/Ms…………… Name(s)…………………………………………………………………..

Address…………………………………………………………………………………………………………..

………………………………………………………………………………………Postcode…………………Telephone……………………………………………Email……………………………………………………

I would like to become a Volunteer (please complete page 2 of this form) /
No. of people / Friends Membership Subscription / Amount
£
Restoration Supporter rate of a minimum £5 per month by Standing Order / Please see below
Full annual rate subscription of £18 per person if you are wagedpayingby Standing Order / Please see below
Full annual rate subscription of £20 per person if you are wagedpaying by cheque or cash
Reduced annual rate subscription of £5 per person if you are unwaged
I would like to make a one-off donation
Total cash or cheque (made payable to Victoria Baths Trust)
I understand Victoria Baths will reclaim 25p of tax on every £1 that I give. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. /
Please tick if applicable

Standing Order

Either: I have created my Standing Order using online / telephone banking

Or:

Your bank...... (e.g., Cooperative Bank plc)

Address of your bank...... Postcode......

Your name(s) (as appears on your account)......

Account Number...... Sort Code…………………………………

Please pay the Co-operative Bank, Olympic House branch Sort code: 08-92-50

For the credit of The Manchester Victoria Baths Trust Account number: 65035968

If you choose a specific date forthe first payment, please allow at least2 weeks from when you send your mandate

The sum of £...... Now/ or on...... (date of your first payment)

And thereafter on the same day every month/ year(please delete as required)

For bank use – please quote the following reference when making payments

Until you receive further notice from me and debit my/our account accordingly

Signature …………………………………………………………………… Date ………………………

Please return this form to:Victoria Baths, Hathersage Road, Chorlton on Medlock, Manchester M130FE

If you have any queries, please contact us on 0161 224 2020 or

SO 10.02.16 Page 1

Volunteering
at Victoria Baths /
Your name
Volunteer role
Which volunteer opportunity are you interested in, and why?
Volunteering with us
Why are you interested in volunteering at Victoria Baths?
Experience
Previous experience, paid or unpaid, which is relevant to this volunteering opportunity
Availability
Which days and times are you available?
Qualifications
If you have qualifications or you are studying at the moment, please give details
Disclosure and Barring Service checks (DBS)
If you will be working with children or vulnerable adults, are you willing to complete a DBS registration form?
Emergency contact details
Please provide the name, address & telephone number of a family member or friend
Signature(Not required if you return the form electronically) / Date

Volunteer Details & Confidentiality

The Trust asks for the information above to provide a starting point for your volunteering at the Baths and for future reference. At the end of your volunteering, you can ask for the information to be deleted and this will be done after 5 years as a matter of course.

Data Protection

The Trust is registered with the Information Commissioner’s Office. In compliance with the Trust’s Data Protection Policy, your information will be kept as securely as we are able and will only be used for volunteer related activities.

In turn, you are required to respect the information of other people.

Please return this form to:Victoria Baths, Hathersage Road, Chorlton on Medlock, Manchester M13 0FE

If you have any queries, please contact us on 0161 224 2020 or

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