MEMBERSHIP DETAILS

LINCOLN CIVIC TRUST

MEMBERSHIP FORM   (Registered Charity Number: 249420)

Ordinary Yearly Subscriber:

Single:  £15.00

Husband & Wife: £20.00

Life Subscriber: Single £150.00
Husband & Wife £200.00

Junior: £5.00

Corporate Business Yearly Rate: £50.00

 

I enclose: £                  as my yearly subscription

 

From: (Please use Capitals)

Name: ………………………………………………………………………………………………………..

Address: ……………………………………………………………………………………………………..

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Post Code: ……………………………          Date of Birth if applicable ………………………..

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LINCOLN CIVIC TRUST LTD
BANKERS ORDER:
TO: ………………………………………….
Address:……………………………………………………………………………………………………
A/c Number: ………………………………..
Please pay to the account of the LINCOLN CIVIC TRUST LTD (A/c No. 00824917 at the National Westminster Bank, Lincoln Smiths (Code 60-13-15), the sum of £ on receipt of this order and continue to pay that amount on 1st January in each year and debit my account with you until further orders from me in writing.

Name: ……………………………………………………………

Signature: ……………………………………………………………

Address: ……………………………………………………………

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(BLOCKED LETTERS)

DATE: ……………………………………

 

 

GIFT AID DECLARATION

ARE YOU A TAXPAYER? IF SO EVERY £1.00 YOU GIVE COULD BE WORTH £1.28 TO US.

ALL WE NEED IS FOR YOU TO TICK THE BOX

[ ] Yes I would like the Lincoln Civic Trust to reclaim the tax on any qualifying donations made by me since 6th April, 2000, until further notice. I confirm that I have paid an amount of UK income tax equal to any tax reclaimed.
Signature: ……………………………………………………………….
Date: ………………………………………
LINCOLN CIVIC TRUST LTD
Registered Charity Number: 249420