GCS MEMBERSHIP APPLICATION FORM

MODULE 1: PERSONAL DETAILS

First Name(s) *

Your Surname *

Title

Family Members

Address *

Town *

Post Code *

Land Line Phone No

Mobile Phone No

Email address *

Today's Date:

MODULE 2: MEMBERSHIP TYPE & PAYMENT

Membership Type

Adult £20 Family £30 Under 18 £15 Over 60 £15 Life £150

Payment Method

Online payment (BACS/PayPal) Standing Order: set up online (preferred) or complete mandate

Additional Donation

Donation Amount (£):

If you are a UK taxpayer, please tick the box so we can claim Gift Aid

MODULE 3: GIFT AID DECLARATION

Gift Aid is reclaimed by the charity from the tax you pay for the current tax year providing you are a current UK taxpayer.

I want to Gift Aid my subscription/donation of £ and any future subscriptions and donations I make or have made in the past 4 years to The Grantham Canal Society. 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 subscriptions and donations it is my responsibility to pay any difference.

Please notify The Grantham Canal Society if you:

want to cancel this declaration
change your name or home address
no longer pay sufficient Tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HMRC to adjust your tax code.

Please complete the Gift Aid declaration to continue.

Declaration Date:

Signature:

MODULE 4: STANDING ORDER MANDATE

Please set up online (preferred) or complete all parts of this form (set the payment instruction date at least 10 days after today's date)

To the Bank Manager at (name of your Bank)

ADDRESS

TOWN

POST CODE

- -

SORT CODE:

ACCOUNT NUMBER:

ACCOUNT NAME (as it appears on your Bank card)

Please pay: Lloyds Bank plc, 12-16 Lower Parliament Street, Nottingham. NG1 3DA

Sort Code: 30-96-18 Account Number: 00401364 To the Credit of: The Grantham Canal Society

The Sum of £ on

AND ANNUALLY THEREAFTER UNTIL FURTHER NOTICE

SIGNED

DATE:

MODULE 5: WHERE DID YOU HEAR ABOUT US?*

Website Social Media Friend/Family Event/Exhibition Other:

Would you like to participate in our brief optional survey?*

This helps us understand our membership better and all data is kept anonymous.

YES - I'd like to help by completing the survey NO - I prefer not to participate

MODULE 6: SURVEY (ANONYMOUS DATA)

This information helps us understand our membership better and is kept anonymous.

Age Group:

Main Interests (tick all that apply):

Canal History Restoration Work Boating Walking Wildlife Photography Other

Would you be interested in volunteering?

Yes Maybe No

Additional Comments: