Wild Flower Society Application Form

Application Form for Membership

of the Wild Flower Society

(Registered Charity No. 271694)

Membership category required

Diary required? Yes No

Name: ______________________________________

Title: _______________________________________

Postal Address including postcode:

____________________________________________

Telephone Number:_____________________________

E-mail Address:________________________________

NB: if you wish to share a magazine, please state who with:

____________________________________________

Date of Birth (Junior only) ________________________

Amount enclosed:_______________________________

I want the Society to treat all donations and subscription payments I make from the date of this declaration until I notify you otherwise as Gift Aid donations.

Signature ________________________________ Date_____________

You must pay an amount of UK Income Tax and/or Capital Gains tax at least equal to the tax that the Society reclaims on your donations in the appropriate tax year (currently 25p for each £1 you give)

You can cancel this Declaration at any time by notifying the Society. If your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the Society reclaims you should cancel your declaration.

Please send the completed forms to: The Membership Secretary, 43 Roebuck Road, Rochester Kent ME1 1UE

Please notify the Society if you change your name or address.