Membership Application

To become a member of Gillingham Local History Society and be a museum supporter please print out this form, fill it in and send (with Gift-Aid form if appropriate)  to
Gillingham Local History Society, Gillingham Museum, Chantry Fields, Gillingham, Dorset   SP8 4UA ENGLAND

Category	Fee (£)
Individual Membership	12.50
Junior Membership (under 16 or still in full time education)	3.00
Life Membership	100.00
Overseas Membership	12.50
I would like to make a DONATION
TOTAL

Name(s) ..........................................................

Address ..........................................................

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Postcode....................................................

Tel No ...........................................................

Email ...............................................................

Signed ...........................................................


GIFT AID
Make every £1 you give through your membership subscriptions or donations worth at least 28% more!

Gift-Aid is a very simple initiative that allows charities like The Gillingham Local History Society to reclaim tax paid on donations.  This can be as much as 28p in the £ but costs you nothing (apart from a few seconds of your time).

By completing this form you are informing us that you pay tax in the UK (income and/or capital gains) at least equal to the tax that we are able to reclaim on your donations in the tax year (currently 28p for each £1).  If you pay tax at a higher rate you can claim further tax relief in your Self-Assessment tax return.

This is a once in a lifetime declaration that will cover all donations from the date below. All we ask is that you notify us in writing if you change your name or address or if your circumstances change and you no longer pay tax.  You may also cancel this declaration at any time.

If you have any queries the local tax office can provide you with a leaflet IR65.

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GIFT AID DECLARATION

Title:

Forenames:

Surname:

Address:



Postcode:

I am a UK taxpayer.  I wish the Gillingham Local History Society to treat all membership subscriptions and donations I make from the date of this declaration until I notify them otherwise as Gift-Aid donations.

Signature:

Date:

The Membership Secretary, Gillingham Local History Society, Gillingham Museum, Chantry Fields, GILLINGHAM, Dorset   SP8 4UA
Registered Charity Number 1014970