Registered Charity No. 244414 www.bristolcivicsociety.org.uk

Membership application - Couple

Annual subscription rate: £30. For the 1st year only it is £15 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 .......................................................................

Partner’s forename………………………………………….and surname ..................................................................

Email ……………………………………………………………………..@ ............................................................................

Phone(s) .....................................................................................................................................................

Standing order mandate To: (name and address of your bank, optional) .........................................................................................

…………………………………………………Account Number ...............…….………………Sort Code .............................

Please pay the sum of £15 fifteen pounds) immediately and then1 annually from 1st of

................................2 20………3 the sum of £30 (thirty 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 2 insert next month 3 insert next year