Membership Form

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Malmesbury River Valleys Trust

Registered Charity No. 1015802      A company limited by guarantee – Reg no. 2771429

Membership Application Form

Please send to our Treasurer Mr A Poolman, Avon House, 25 Abbey Row Malmesbury, Wiltshire, SN16 0AG   Tel. 01666 826363

I/We wish to support the Trust by becoming a member

Name ……………………………….               Phone………………………………

Address………………………………               Email……………………………….

………………………………

………………………………

I/We would like to become (a) life member(s) and enclose *£50 individual/£100 family

OR      to pay an annual subscription by standing order

 individual         *           £8

 family                 *           £16

I/We would also like to make a donation and enclose            *          £__

* Delete that which does not apply

Gift Aid   The Trust is able to claim from HMRC 25p for every pound of your donation, provided that you pay income tax at least to that amount. Please complete the following declaration:

“I am a UK tax payer and wish the Trust to treat all my subscriptions/donations from April 2005 and until I advise it otherwise as Gift Aid Donations. “

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

………………………………………………………………………………………………………….

Bank Standing Order Form

To your bank                                                                                       From you

Name……………………………….                            Name…………………………………

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

……………………………..                                         ………………………………….

……………………………..                                         ……………………………….

Postcode……………………………                           Postcode…………………………….

Please pay to Malmesbury River Valleys Trust at Co-operative Bank, Skelmersdale   Code 089299       A/c No. 65131260

the sum of £…………. on the date of receipt by you of this order and annually on the same date thereafter until cancelled by myself and debit my account  No…………………. in the name of …………………….

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

Send to Treasurer for registration who will send to bank.