Members Booking and Membership Renewal Form 2018

Medical Music Society of London

Members’ booking and membership renewal form 2018

Castalian Quartet: Wednesday 11th April 2018 at 7 pm

No. of tickets / Description / Price / Total
Concert, interval drink & post-concert buffet supper (main course, with vegetarian option, salad, dessert, wine, tea/coffee) / £54 / £
Concert & interval drink only / £25 / £

Aquinas Piano Trio & Friends: Wednesday 4th July 2018 at 7 pm

Busch Trio: Thursday 18th October 2018 at 7 pm

If not already renewed, please add £15 to renew your subscription to MMSoL for 2018

1 / MMSoL membership renewal 2017 / £15

Now – 31st December 2018. Only one member per household required. Members may purchase tickets for their guests at members’ prices, up to a total of 6 per concert. Please complete Gift Aid form on next page.

GRAND TOTAL / £

Please complete payment details on next page….

1. I enclose a cheque for £ payable to Medical Music Society of London, and a stamped addressed envelope for tickets to be sent to me. (Please post your completed form, cheque and SAE to the address below)

2. I have made payment of £ by online banking direct to Medical Music Society of London, account number: 00022267, sort code: 40-52-40 and included my surname as the payment reference. (Please either email your completed form, or post it to the address below)

Name:

Address:

Email:

Tel:

Our address: Medical Music Society of London, 3 Butlers Close, Amersham, Bucks, HP6 5PY

Tel: 07925 885601 Email:

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Charity Gift Aid Declaration

Boost your donation by 25p of Gift Aid for every £1 you donate

Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

In order to Gift Aid your donation you must tick the box below:

¨ I want to Gift Aid my donation of £15 and any donations I make in the future or have made in the past 4 years to: Medical Music Society of London (Registered charity: 1157835)

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 it is my responsibility to pay any difference.

My Details

Title: First name or initial(s):

Surname:

Full Home address:

Postcode: Date:

Please notify the charity if you:

· want to cancel this declaration

· change your name or home address

· no longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code