Membership application - Student Annual subscription rate: £10. For the 1st year only it is £5 if a standing order is set up. Please return to: Membership Secretary, Bristol Civic Society, 5 Smyth House, Bridge Road, Bristol BS8 3PE. Enquiries:
Tel: 0117 974 3637 Email: membership@bristolcivicsociety.org.uk By completing this Gift Aid Declaration, Bristol Civic Society can increase the value of your subscription at no additional cost to you.
I would like Bristol Civic Society to treat all donations I have made in the last four years and until further notice as Gift Aid donations. My annual income tax and/or capital gains tax is at least equal to the amount of tax that all organisations I support will reclaim in the appropriate tax year - currently 25p for every £1. I understand that other taxes such as VAT and council tax do not qualify. Please tick box:
YES
NO
Please write your email address below if you would like to receive the Society’s monthly email bulletin and your phone number if case of queries:
Forename………………………………………………………….Surname ....................................................................... Email ……………………………………………………………………..@............................................................................ Phone(s) .....................................................................................................................................................
Standing order mandate To: (name and address of your bank, optional) ......................................................................................... …………………………………………………Account Number ...............…….………………Sort Code ............................. Please pay the sum of £5 (five pounds) immediately and then1 annually from 1st of ................................2 20………3 the sum of £10 (ten pounds) to CAF Bank Ltd (sort code 40-52-40) for the account of Bristol Civic Society (account no. 00087355) quoting reference no. .....................(for completion by Bristol Civic Society).
Name .......................................................................................................................................................... Address ...................................................................................................................................................... Date……………………………… Signature .......................................................................................................... 1
delete words in italics if your first year subscription is paid by cash or cheque insert next month 3 insert next year 2
Registered Charity No. 244414
www.bristolcivicsociety.org.uk