Please complete the panels on this screen, then print out the page, complete, sign and date it and mail to the address below

Membership Application Form

I wish to apply for (membership/membership renewal *) of Hampshire and the Islands Historic Churches Trust   * delete as appropriate

Name

Title
Churches: please list contact's details with church's name & place in brackets

Address

 

 

Post Code

Type of membership required:

Email Address

Please tick as appropriate, Annual Patron must complete both Standing Order Mandate and Gift Aid Declaration

()  I enclose a cheque for £ ……… made out to: Hampshire & the Islands Historic Churches Trust
OR
()  I have completed the Banker’s Standing Order Mandate - which helps for any membership.
OR
()  I have completed the Gift Aid Declaration - which helps in all cases.

AND for Patrons
()  Please tick if we can list you in our Annual Report

Signed…………………………………………………………Date……………………………….

As a member of the Trust I am happy to receive communications regarding the activities of the Trust and to have my name and address on your records. I understand that this information will not be communicated to other persons or organisations.

.....................................................................................................................................................................................

Gift Aid Declaration

This Declaration will enable the Trust to recover income tax and should only be completed if you are a UK tax payer. You are able to cancel this authority if your circumstances change.

Declaration
I confirm that I am a UK tax payer and I pay an amount of Income Tax and/or Capital Gains Tax for each tax year that is at least equal to the amount of tax that the Trust will claim on my gift,
I authorise Hampshire and the Islands Historic Churches Trust to recover Income Tax at the Standard Rate on all my recorded gifts to its funds made in the last six years and all future gifts from the date of this declaration are to be treated as Gift Aid donations, until this authority is cancelled in writing.

Name

Title

Address


Post Code


Signed…………………………………………………………Date………………………………

Please send this form to: Membership Secretary HIHCT, 32, Sutherland Close, Bordon GU35 9RF

Hampshire and the Islands Historic Churches Trust
Registered Charity No 299633