The Gloucestershire Group of the
RoSPA Advanced Drivers and Riders
Charity No 1090617

I apply for membership of The Gloucestershire Group of the RoSPA Advanced Drivers and Riders (full driving licence required). [Click in each space to select or enter text before printing or e-mailing]

Title / Forename / Surname/
Family Name
Select Ms/ Mrs/ Miss/ Mr/ Mx /
Address: / Mobile phone:
House name: /
No & street: / Home phone:
Locality name: /
Town: / E-mail:
Postcode: /
Vehicle Make / Model / Transmission
< Select Manual/Auto/CVT/DCT/EV > /
Full Car Licence Type: / < Select B / B Auto/ Non-UK / Full Motorcycle Licence Type: / < Select A1/ A2/ A/ Non UK /
Section I wish to join: / < Select Car/ Motorcycle > / Membership of both sections is possible after passing the advanced test in one section.
Where did you hear about us?
< > /
Boost your donation by 25p of Gift Aid for every £1 you donate
Gift Aid is reclaimed by the Gloucestershire Group from the tax you pay for the current tax year.
Please tick the box below:
☐ / I want to Gift Aid my donation and any donations I make in the future to: The Gloucestershire Group of the RoSPA Advanced Drivers and Riders. 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.
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
Agreed (e-mail version tick in box) / ☐ / Date (dd/mm/yyyy): < >
Signed (postal version – if relevant) / ______

Your information will be used to manage and administer the GloucestershireGroup and your membership. It will not be used for any other purpose. See our website: for more detail.

How to pay:Associate Membership is £30 annually. Full Membership (advanced test passed and current) is £15 annually
(all at 33⅓% discount if aged25 or under).

Online banking option:

Step 1: Pay CAF Bank, sort code: 40-52-40, account number: 00022509, account name: Glos. RoSPA ADAR, payee/reference: your surname and initial(s), method to pay is Standing Order / Bank Giro Credit / Faster Payments Scheme.

Step 2: Save this form using filename: [Surname_Firstname] Membership Form.doc and e-mail to:

Postal option:

Cheque made out to ‘Glos. RoSPA ADAR’posted with your application to: Glos RoADAR Treasurer, The Dell, Pike Lane,
Frampton Mansell, Gloucestershire, GL6 8JB

2018 VMar31