OLD PHAROSIANS' ASSOCIATION

MEMBERSHIP FORM

Section A - to be completed by all members

Name: …………………………………………………………….  Years at school: …………………..

Address: …………………………………………………………………………………………………

…………………………………….  Post Code: ……………………  Home phone: ………………….

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

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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: …………………………………….

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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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