Please complete,print and send to

Paul Catherall, Membership Secretary,

Holm Oak, Mount Park Avenue, Harrow, Middx, HA1 3JN

 

Application Form

 

 

¨

Household Member(s)

Household membership is a minimum of £5.00 per annum (or £3 for senior citizens), although many of our members contribute more.  For Household Members, please state the number of adults in the household. This is useful when estimating total membership during evidence to planning enquiries.

 

 

Number of adults in household

 

 

 

¨

Corporate Member

 £25.00

 

 

E-mail address

 

 

 

 

Name

 

 

 

 

Address

 

 

 

 

Address

 

 

 

 

Address

 

 

 

 

Address

 

 

 

 

Postcode

 

 

 

 

 

I/We wish to pay our annual subscription on 1st September by:

 

            ¨ Banker's Standing Order            ¨ Cheque

 

We urge you to pay by Banker’s Standing Order as this saves unnecessary annual reminders.

 

Banker’s Standing Order

 

To

 

 

 

(Bank)

 

 

(Branch Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank Sort Code

 

 

 

 

 

 

 

Account Number

 

 

 

Please pay the sum of

 

Amount in figures

Amount in words

 

£

 

 

 

 

For the credit of

 

 

The Harrow Hill Trust

National Westminster Bank plc

Harrow

Bank Sort Code 60 10 10 Account number 37928902

On 1st September of each year until further notice.  Please cancel any previous standing orders in favour of this beneficiary

 

 

Signature

 

Date

 

Name (in CAPITALS)

 

 

 

Gift Aid

 

 

The Trust can claim back tax on your subscriptions provided you are an income tax payer and have completed a Gift Aid Declaration, so we hope you will complete this simple form now.  It will remain in force as long as you remain a member, unless you wish to cancel it at any time (for example if you cease to be a tax payer).

Please do not complete this form if you do not pay income tax.

 

 

 

 

Gift Aid Declaration

 

 

To: The Harrow Hill Trust

 

 

Title and Full Name___________________________________________________________________________________________

 

Address (if different from membership)__________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

 

 

I am a UK tax payer and wish The Harrow Hill Trust to claim back the tax on all payments I have made/ shall make from 6 April 2007 and until I notify you otherwise

 

 

Signed

 

Date

 

 

 

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