Gwent Wildlife TrustNew Membership

Please enter your information and send the form, together with your payment or completed Direct Debit Mandate form, to:

Gwent Wildlife Trust, Seddon House, Dingestow, Monmouth NP25 4DY

T 01600 740600 E W

All subscriptions shown are the minimum payable. Many members pay more, for which the Trust is very grateful.

What can you afford to help look after our local wildlife?

Please select the type of membership you require.If paying by Direct Debit, please complete the Mandate below.

GWT Membership Subscriptions

[ ]Annual Individual£30 per year

[ ]Annual Joint£36 per year

[ ]Annual Family£42 per year

[ ]Annual Other amount£… per year

[ ]Monthly Individual£2.50per month

[ ]Monthly Joint£3.00 per month

[ ]Monthly Family£3.50per month

[ ]Monthly Other amount£…… per month

Monthly Payments by Direct Debit Only

Title: Forename: Surname:
Title: Forename: Surname:
Address:
Postal Town: Postcode:
Tel: Email:
Contact Preferences
In addition to receiving my membership mailings, I am happy to receive information about GWT’s work for wildlife including events, volunteering, fundraising and other activities by:
Post Email Telephone Text Please tick all that apply.
Your details will only be used by Gwent Wildlife Trust. We will never sell or give your details to any third party.
Gift Aid Declaration
If you are a UK Tax Payer, we can reclaim the tax paid on your membership and other donations, now and in the future, at no extra cost to you. We can reclaim 25p of tax for every £1 that you give. Please let us know if you change your name, address or cease to be a Tax Payer.

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year (6th April to 5th April), it is my responsibility to pay the difference.
Signature: Date:

For family membership please give names and dates of birth (DOB):

Name… … … … … … … … … … …DOB… … … … …Name… … … … … … … … … … …DOB… … … … …

Name … … … … … … … … … … …DOB … … … … …Name … … … … … … … … … … …DOB … … … … …

______

Direct Debit Mandate - Gwent Wildlife Trust

Instruction to your Bank or Building Society to pay by Direct Debit

Bank/Building Society

Name of Account:

Sort Code:

--- / ---

Account Number:

Originator’s Identification No:

9 / 8 / 5 / 5 / 8 / 2

Reference No (Office Use Only):

R / E

Please pay Gwent Wildlife Trust Direct Debits from the account detailed in this instruction, subject to the safeguards assured by the direct debit guarantee. I understand that this instruction may remain with Gwent Wildlife Trust and, if so, details will be passed electronically to my Bank or Building Society.

Signature(s):
Date:

Banks and Building Societies may not accept Direct Debit instructions for some types of accounts.

Direct Debit Guarantee

  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
  • If there are any changes to the amount, date or frequency of your Direct Debit, Gwent Wildlife Trust will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Gwent Wildlife Trust to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
  • If an error is made in the payment of your Direct Debit by Gwent Wildlife Trust or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society.
  • If you receive a refund you are not entitled to, you must pay it back when Gwent Wildlife Trust asks you to.
  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify Gwent Wildlife Trust.