Membership Application E-Form 2017

Please Read Membership Details before Using This E-Form.

CHESTER CIVIC TRUST
Membership On-Line APPLICATION Form

I/we wish to apply for membership as follows.
(Please choose the appropriate category in the drop down list).

Membership Type

*Concessionary rates are available to:
* Full-time students
* Those in receipt of Jobseeker's Allowance, Income Support, Family Credit or Council Tax Relief,
but NOT State Pension (unless you also receive one of the above benefits).

- - - - - - - - - - - - - - -PAYMENT - - - - - - - - - - - - - - -
EITHER
My/Our cheque payable to Chester Civic Trust in the sum of £..........will be sent by me/us on successful submission of the E-Form.

OR
I/we will transfer the sum of £.......... to Chester Civic Trust via BACS after successful submission of this e-form.
Sort Code 604008 A/C Number 32508816

APPLICANT NAME

JOINT MEMBER NAME

ADDRESS

POST CODE

TELEPHONE

EMAIL ADDRESS

For Family membership please give names of children still at school

GIFT AID DECLARATION
I confirm that I would like all subscriptions/donations I make from the date of this declaration, until I notify you otherwise, to qualify under the Gift Aid scheme. This declaration will enable the Chester Civic Trust to reclaim tax on your subscription. For this to be done, you must pay Income Tax or Capital Gains Tax at least equal to the amount of tax that the Trust reclaims on your donations for the tax year (currently 28p for every £1 you give).

Please indicate your choice by clicking one of the following two buttons.
Do you wish to make the above Gift aid Declaration? - Yes pleaseNo thank you

Registered Charity No. 504634
Submit