OLD PHAROSIANS' ASSOCIATION

 

MEMBERSHIP FORM

 

Section A - to be completed by all members

 

Name: .  Years at school: ..

 

Address:

 

.  Post Code:   Home phone: .

 

Email address: .....................................................

__________________________________________________________________________________

 

Section B - to be completed by all members

 

BANKER'S ORDER

 

To:       The Manager .. Bank Plc (name of member's bank)

 

            (address of member's bank)

 

            Account number: .  Date:

 

Please pay on 1st August next to Lloyds TSB Bank Plc (sort code 30-93-34) Market Square, Dover, Kent for the credit of the Old Pharosians' Association, account 1991864 the sum of 5.00 (five pounds only) and continue this amount annually, on the same date, without application, from my account identified above.

 

Signature: .

__________________________________________________________________________________

 

Section C - to be completed by members who are UK taxpayers and who wish to provide additional benefit to the Association under "Gift Aid".

 

GIFT AID DECLARATION

 

Full name: .  Title: .

 

Address : ...

 

.  Post code:

 

I confirm that I am a UK taxpayer and want the Old Pharosians' Association to claim back the tax on the donation of 5 I made on  //, and all donations I make after the date of this declaration, under the Gift Aid measures.

 

I confirm that I will be paying income tax or capital gains tax of more than the tax the Association will reclaim on my donation (28p for every 1 donated).

 

Signature:

 

Date:

 

Please return the whole form to the Membership Secretary, Old Pharosians' Association,

Little Rock, 6 Park Road, Temple Ewell, Near Dover, Kent, England. CT16 3AJ.

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