MEMBERSHIP
APPLICATION FORM
2015
Please Note:
Your Membership Subscription year runs from the1st of the month for a 12 month period after receipt of your completed and signed Application Form.
Membership Subscription via Direct Debit
If paying by Direct Debit, The British Chelonia Group has appointed the BACS Approved Direct Debit Bureau, Eazy Collect Services Limited (www.eazycollect.co.uk) to collect your payments and Eazy Collect Services Limited will be shown on your Bank Statement.
Direct Debit payments are deducted either:
1st February, 1st April, 1st June, 1st August, 1st October or 1st December.
The amount deducted will be as shown on your Application Form.
A full list of current types of Membership and Annual Subscription Rates is shown overleaf.
THE BRITISH CHELONIA GROUP
CONSERVATION APPEAL FOR THE YEAR 2015 is:
SOPTOM
THE TORTOISE VILLAGE
FRANCE
For tortoise, terrapin and turtle care and conservation
Company Limited by Guarantee (England and Wales) No.07541800.
Registered Charity No.1140830. The British Chelonia Group Registered Office:
Cowley Cottage, 1 High Street, Sutton Benger, Chippenham, Wiltshire SN15 4RE
www.britishcheloniagroup.org.uk
Mr/Mrs/Miss/Ms/Dr/Prof/Other
First Name Surname
Address
Town/City County Post Code
Tel No (incl STD code) E-mail
GIFT AID Declaration – for past, present & future donations
Please treat as Gift Aid donations all qualifying gifts of money made today, in the past 4 years, and in the future. Please tick all boxes you wish to apply. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.
Please remember to notify The British Chelonia Group if you wish to cancel this declaration, change your name or home address, or 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.
Signature Date
Membership Required (see page 3) 1a : 1b : 1c : 1d : 2 : 3 : 4
New Member Yes / No Membership Fee £………………
Renewal Yes / No Yearly Appeal Donation £………………
Membership No Total (enclosed or to be debited on a yearly basis) £………………
Signature Date
Service User Number
4 / 1 / 9 / 1 / 0 / 5Instructions to your Bank or Building Society: Please pay Eazy Collect Services Limited on behalf of The British Chelonia Group from the account detailed in this instruction subject to safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with The British Chelonia Group and details will be passed electronically to my Bank or Building Society.
Name(s) of Account Holder(s)
Bank/Building Society Account Number
Bank Sort Code Name of Bank/Building Society
Account Holders Signature(s) Date
Types of Membership Annual Subscription Rate
1 United Kingdom
(a) Individual Membership £16.00
(b) Family Membership £21.00
(2 adults at the same address and their children under 18)
(c) Individual Contributing Member £21.00
(d) Family Contributing Members £26.00
2 Senior Citizens (UK only) £13.00
3 Overseas – Please pay in Pounds Sterling only £28.00
4 Students (Animal Related Subjects only). £10.00
Proof of College/University attended and course(s)
undertaken may be asked for
Contributing Membership includes a £5 donation to The British Chelonia Group funds.
This extra income will be used as grants to Tortoise, Turtle and Terrapin studies or conservation projects throughout the world, to purchase material for publication and to support other chelonian projects as agreed by the Trustee Directors. This £5 is separate from the Annual Appeal.
Cheques/Postal Orders should be made payable to
The British Chelonia Group
and sent to:-
Membership Secretary
The British Chelonia Group
PO Box 16216, Tamworth B77 9LA
If you are renewing your Membership and wish to receive an up-to-date Membership Information Booklet, please enclose a 9 x 6.5 inch Stamped Addressed Envelope
The 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, Eazy Collect or The British Chelonia Group will notify you ten days in advance of your account being debited or as otherwise agreed.
- If you request Eazy Collect or The British Chelonia Group to collect a payment,
confirmation of the amount and date will be sent to you within ten days or as otherwise agreed.
- If an error is made in the payment of your Direct Debit, by Eazy Collect, The British Chelonia Group 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 The British Chelonia Group 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 us.
Member’s Name Membership No
SPECIES KEPT(Please complete) / ADULT
11 YEARS
AND OVER
M F / JUVENILES
5 – 11
YEARS
M F / HATCHLINGS
0 – 5
YEARS
Hermann’s Tortoise
(Testudo hermanni)
Spur-thighed Tortoise
(Testudo graeca)
Horsfield Tortoise
(Testudo horsfieldi)
Marginated Tortoise
(Testudo marginata)
Leopard Tortoise
(Stigmochelyspardalis)
Sulcata Tortoises
(Geochelone sulcata)
Others
(please state species)
1. Are you willing to accept unwanted Chelonia?
(A) Tortoises YES / NO
(B) Terrapins YES / NO
2. Do you have facilities to accept sick / injured / blind Chelonia?
(A) Tortoises YES / NO
(B) Terrapins YES / NO
1