If you prefer to print a form and fill it in by hand please click here for a printable form
Title Mr.Mrs.Ms.Other
First Name
Last Name
Address line 1
Address line 2
Postcode
Land line phone
Mobile phone
Email
Are you joining as a couple? yes to Couple/joint membership
Gift Aid legislation allows The Society to reclaim 25p on every £1 that you give on your subscription and additional donations. Please state that you are happy for us to do this by ticking the box below.
yes to Gift Aid
Doing so will confirm that you wish The Burtons’ St Leonards Society to benefit from Gift Aid legislation. You confirm that you are a UK taxpayer and have paid or will pay an amount of income tax and/or capital gains tax that is at least equal to the amount reclaimed on ALL your Gift Aid donations (not just to the The Burtons’ St Leonards Society) for each tax year. Other taxes such as VAT and Council Tax do not qualify. This declaration also applies to future subscriptions and donations.
Bank transfers should be made to Sort Code 40-40-09 and Account 01215248. We are a business as well as a charity, so please tick that box when making the transfer. Please enter the date of transfer and your name as payment identification in the box below.
You must agree to us contacting you by email before sending this form. I agree
