LEICESTER LITERARY AND PHILOSOPHICAL SOCIETY SECTION C GEOLOGY

 

MEMBERSHIP FORM 2011-12

Rates   (please tick required boxes). Subs due on 1st October 2011.

 

Single                £7.00                             Student £5.00 

Family/Joint    £10.00                      Parent Body £5.00  

Paid by CASH      ,   CHEQUE        or STANDING ORDER  

 

Please make all cheques payable to: Leicester Literary & Philosophical Society Section C Geology.

Title     __________    Name     _____________________________________

 

Address________________________________________________________

 

 _____________________________________ Post code________________

 

Tel No. _____________________   Signature __________________________

 

Email__________________________________________________________

GIFT AID DECLARATION

I would like all donations I have made since 6th April 2000, and all donations I make in the future to be made through Gift Aid until I notify you otherwise.  I confirm I am a U.K. taxpayer and that the amount of tax I pay does not exceed the amount I would like this Society to reclaim. Yes  ____     No ______

DATA PROTECTION ACT

I agree to my details being held on the Section C membership database.

 

Signature _________________________________________

Your details will not be passed on to any third parties or any other organisation.   

Please post completed form to:

Mrs Fiona Barnaby, Cuckoo Cottage, 22 Church Lane, Dingley, Market Harborough, LE16 8PG

STANDING ORDER

Please fill in the mandate below and set up payment with your bank. Please still post the membership renewal form to the Treasurer.

LEICESTER LITERARY & PHILOSOPHICAL SOCIETY

SECTION C GEOLOGY

 

BANK STANDING ORDER MANDATE

 

To: The Manager of

Bank Address

 

 

Please pay the sum of £    .     on the 1st October 2011.   

 

LLOYDS TSB BANK, COALVILLE BRANCH

 

Account Name:  Leicester Literary & Philosophical Society   Section C Geology

 

Account No:         1348768              Sort code: 30-92-15

 

Customer Reference _________________________________

(Please use your surname and initials)

 

Name _____________________________________________

 

Account No.________________________________________

 

Signature __________________________________________

 

Date ______________________________________________

 
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