Membership Application Form

If you would like to join Bristol Civic Society, please print out the form below, fill it in and send it to:

Derek Warwick, Membership Secretary, Bristol Civic Society, 22 Fallodon Court, Henleaze, Bristol, BS9 4HQ.

If you would prefer to receive an application form by post, please contact the Membership Secretary at the above address or ring him on (0117) 962 1526 or send an e-mail to contact@bristolcivicsociety.cjb.net.

 

Please enrol me as a member of Bristol Civic Society Mr/Mrs/Miss/Ms ................................................................................................................ Address ............................................................................................................................ ......................................................................................................................................... Postcode ....................................................... Tel. ............................................................ Membership Subscriptions - please tick ordinary single £13 [ _ ] concessionary* single £10 [ _ ] ordinary double £20 [ _ ] concessionary* double £15 [ _ ] associate membership for schools, companies and voluntary organisations £20 [ _ ] * concessionary rates apply to young people under 18, students and senior citizens You may pay your subscription either by cheque payable to Bristol Civic Society or by Banker's Order (please also complete the form below and send it with your first year's subscription to the Membership Secretary. This instructs your bank to renew your subscription every year until further notice). Additionally, if you complete the Gift Aid Declaration (bottom), the Civic Society can substantially increase the value of your subscription at no additional cost to you by claiming a tax refund. Banker's Order Form Name of your Bank .......................................................................................................... Bank address .................................................................................................................. Please pay the sum of £ ............... to Lloyds TSB Bank plc, Kingswood Branch, 102 Regent Street, Kingswood, Bristol, BS15 2HT (code no. 30-94-80) for the account of Bristol Civic Society (account no. 0663177) on January 1st next and continue to pay this sum annually until these instructions are amended or cancelled by me. Name .............................................................................................................................. Account Number .............................................................................................................. Address .......................................................................................................................... ........................................................................................................................................ Signature .......................................................................Date .......................................... Please return to the Membership Secretary with a cheque for your first year's subscription. Gift Aid Declaration Details of donor: Title .......... Forename(s) ................................................................................................. Surname ........................................................................................................................ Address ......................................................................................................................... ...................................................................................................................................... ......................................................................... Post Code ............................................ I want Bristol Civic Society to treat all donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations. Signature .................................................................. Date ............................................ Please note: In order for Gift Aid to apply, you must ensure that you pay an amount of income tax and/or capital gains tax equal to that which we will reclaim (currently 28p in each £1 you give). If you pay tax at the higher rate, you can claim further tax relief in your Self-Assessment tax return. Your declaration will continue until you cancel it, so please let us know if you change your name or address. You can cancel this declaration at any time by letting us know in writing. You may need to do this if your tax status changes. Bristol Civic Society is a registered charity, no. 244414