an independent force for a better Bristol

www.bristolcivicsociety.org.uk Registered charity No. 244414

Membership application - Student

Annual subscription rate: £10. Please return to: Membership Secretary, Bristol Civic

Society, 47 Abbey Rd, Bristol BS9 3QN. Cheques made payable to Bristol Civic Society if

you are not paying by standing order.

Enquiries: Tel: 0117 9622475 Email: membership@bristolcivicsociety.org.uk

By completing this Gift Aid Declaration, Bristol Civic Society can increase

the value of your subscription at no extra cost to you by claiming a tax refund.

I would like tax to be reclaimed on my donation under the Gift Aid Scheme. I am a UK tax

payer and pay an amount of income tax and/or capital gains tax at least equal to the tax

that can be reclaimed on my donation.

Please tick. YES NO Please write your email address below if you would like to receive news of events and the

Society’s email bulletin and your phone number if case of queries:

Forename………………………………………………….Surname ........................................................

Email…………………………………………….@ .............................................................................

Phone(s) ..................................................................................................................

Standing order mandate

To: (name and address of your bank, optional) .............................................................

...............................................................................................................................

Account Number ............................…….………Sort Code ................................................

Please pay annually from 1st of ................................1 20………2 the sum of £10 (ten

pounds) to CAF Bank Ltd (sort code 40-52-40) for the account of Bristol Civic Society

(account no. 00087355) quoting reference no. .....................(for completion by Bristol

Civic Society).

Name .......................................................................................................................

Address ....................................................................................................................

Date……………………………… Signature ..............................................................................

1 insert next month 2 insert this year