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.

Web site form