Membership Form
1
Mapa Scotland THE CAMPAIGN TO RESTORE THE GREAT POLISH MAP OF SCOTLAND MEMBERSHIP APPLICATION FORM Title: ____________ First name: ___________________________ Surname: _________________________________ Address & Post Code: ________________________________________________________________________________ ________________________________________________________________________________ Email: ____________________________________________________ Phone: __________________________________ Subscription: £________________ Donation: £______________ Annual membership subscriptions: Individual: £10 Family: £15 Voluntary group: £20 Public body: £50 Payment can be made by: (i) Cheque. Payable to Mapa Scotland. (ii) Internet Banking. Lloyds Bank, sort code 30-71-84, a/c no 17186768, Mapa Scotland. Please remember to add your name as a reference so we can identify payments. Gift Aid: For every £1 subscription/donation, Mapa Scotland receives an extra 25p I would like the tax to be reclaimed on any eligible donations or subscriptions that I have made since 28/6/2012 or will make until further notice. I confirm that I pay an equal amount of UK income or capital gains tax at least equal to the tax that Mapa Scotland and any other charities that I donate to will reclaim. I agree (tick)......... Data Protection: Mapa Scotland does not share your details with anyone else. The information you have supplied will only be used to keep you informed about Mapa Scotland's work. Signed: ______________________________________________________________________ To ensure that we have your details, and Gift Aid declaration, please post or email this form to - Nigel Rose, Membership Secretary - 39 Fox Covert Avenue, Edinburgh EH12 6UH E-mail: [email protected] Secretary - Keith Burns Tel: 01620 860257 E-mail: [email protected] www.facebook.com/mapascotland www.mapascotland.makers.org.uk Scottish Charitable Incorporated Organisation - No. SC043255
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On Line Application form for membership
Transcript of Membership Form
Mapa Scotland
THE CAMPAIGN TO RESTORETHE GREAT POLISH MAP OF SCOTLAND
MEMBERSHIP APPLICATION FORM
Title: ____________ First name: ___________________________ Surname: _________________________________
Address & Post Code: ________________________________________________________________________________
________________________________________________________________________________
Email: ____________________________________________________ Phone: __________________________________
Subscription: £________________ Donation: £______________
Annual membership subscriptions:Individual: £10 Family: £15 Voluntary group: £20 Public body: £50
Payment can be made by:(i) Cheque. Payable to Mapa Scotland.(ii) Internet Banking. Lloyds Bank, sort code 30-71-84, a/c no 17186768, Mapa Scotland.
Please remember to add your name as a reference so we can identify payments.
Gift Aid: For every £1 subscription/donation, Mapa Scotland receives an extra 25pI would like the tax to be reclaimed on any eligible donations or subscriptions that I have made since 28/6/2012 or will make until further notice. I confirm that I pay an equal amount of UK income or capital gains tax at least equal to the tax that Mapa Scotland and any other charities that I donate to will reclaim. I agree (tick).........
Data Protection: Mapa Scotland does not share your details with anyone else. The information you have supplied will only be used to keep you informed about Mapa Scotland's work.
Signed: ______________________________________________________________________
To ensure that we have your details, and Gift Aid declaration, please post or email this form to - Nigel Rose, Membership Secretary - 39 Fox Covert Avenue, Edinburgh EH12 6UH
E-mail: [email protected]
Secretary - Keith Burns Tel: 01620 860257 E-mail: [email protected] www.facebook.com/mapascotland www.mapascotland.makers.org.uk
Scottish Charitable Incorporated Organisation - No. SC043255
