Membership form
Saturday, 17th October 2009
Membership Form
Membership for individuals is £15 and for families and institutions £20.
Please print this page (use print icon above right) and send the first and third parts to the Membership Secretary (Miss P Aldabella, 5 John Gray Court, Main Street, Willerby, E Yorks, HU10 6XZ); the second (if used) to your bank.
Application for membership
I/we wish to join the Society for the year commencing 1st Jan .....................
Mr/Mrs/Miss (please print) ................................................ Date .............
Address ................................................................................................
............................................................................................................
I enclose £ ...... or banker's order (see below) (The Society is unable to arrange payment by Direct Debit)
East Yorkshire Local History Society Banker's Order
To Messrs ...................................................... Bank
Address .................................................................................................
Please pay to the account 0105 8029 of the East Yorkshire Local History Society at the HSBC Bank, 63 Market Place, Beverley, sort code 40 10 12, from my/our account number ........................ the sum of £ ........ now and on the first day of January each year until further notice. This instruction cancels and supersedes any existing arrangement
Signed ............................................. Date ..................
Address .................................................................................................
.............................................................................................................
Gift Aid Declaration by the person named below:
I want the charity to treat the enclosed subscription of £ ........ and all further subscriptions until further notice as Gift Aid donations.
Name ............................................. Signed ............................................
Date ..........................
You can cancel this declaration at any time by notifying the charity. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year. If in the future your circumstances change and you no longer pay tax, you can cancel the declaration.
