MEMBERSHIP APPLICATION FORM

I would like to apply for individual membership of the Community Foundation and agree to pay the following subscription:

£ Annual Individual Membership £80.00
£ Lifetime Individual Membership £1,600

£ I enclose a cheque for £ ______(Payable to Community Foundation)

£ I have completed a standing order form.

£ I would like the Community Foundation to treat all donations I have made in the past 4 years, and all donations I make from the date of this declaration until I notify you otherwise, as Gift Aid donations.*

You must pay an amount of income tax and/or capital gains tax in the year at least equal to the tax that the Community Foundation will claim from HM Revenue & Customs on your Gift Aid donations.

Name:
Address:
Telephone: / Fax:
Email:

We are required under data protection legislation to clarify with you the ways in which you are willing to hear from us. We do not supply our mailing list to any other organisation. We may want to send you additional information about our activities and funding opportunities.

I would like to receive this by £ Mail £ Phone £ Email

I would not like to receive this information £

Signed ______

Date ______

BANKER’S ORDER FORM FOR MEMBERSHIP SUBSCRIPTIONS
Your full name in
CAPITALS / I, ______
Mr, Mrs, Miss or Title
Address in CAPITALS / of
______
______
______Postcode______
request you to pay BARCLAYS BANK PLC (20 60 03), WINGROVE BRANCH for the credit of the COMMUNITY FOUNDATION A/C No. 70992631
Quoting Ref no:
I would like this donation to be made to the Community Foundation serving Tyne & Wear and Northumberland.
Amount you wish to pay each year for membership subscription / the sum of ______
______
amount in words
£______annually
amount in figures
Date when payments are to start / starting on ______until further notice
Your signature and date / ______20 _____
signature
To ______
name of your bank
of ______
______
address of your bank
Account No ______Branch Sort Code______

Please return this form to:

Community Foundation, Philanthropy House, Woodbine Road, Gosforth, Newcastle upon Tyne, NE3 1DD Tel. 0191 2220945 Fax:0191 2848413