Friends' Membership Application Form

The Friends of The Shropshire Music Trust

MEMBERSHIP APPLICATION FORM

I / we would like to apply for annual membership of The Friends of The Shropshire Music Trust and:
   + enclose a cheque payable to The Friends of The Shropshire Music Trust for £6 / £10 or £ _ _ _
   + enclose the completed Standing Order Form.
   + I have completed the Gift Aid declaration (or) I am currently not a UK taxpayer
        (please delete as appropriate)

Title _ _ _ Forename(s) _ _ _ _ _ _ _ _ _ _ _ _ Surname _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Postcode: _ _ _ _ _ _ _ _ _

GIFT AID DECLARATION:

I want The Friends of The Shropshire Music Trust to reclaim tax on all donations I make on or
after the date of this declaration and treat them as Gift Aid Donations.

I confirm that I currently pay an amount of income tax or capital gains tax at least equal to the
amount to be reclaimed, and I expect this situation to continue.

I am under no commitment to make any further donations and I may cancel this declaration in
respect of future donations at any time.

I will advise The Friends’ Treasurer if I change my address at any time during the currency of
this declaration.

Signed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ _ _ _
To: J W Lees, Treasurer, 21 Mytton Oak Road, Shrewsbury, SY3 8UA

STANDING ORDER FORM:
To The Manager _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(Name of Bank)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(Branch Name)

Please pay The Friends of The Shropshire Music Trust £ _ _ _ _ _
Amount in words: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Starting on _ _ / _ _ / 200 _ and the same amount on the _ _ _ day of _ _ _ _ _ _ _ _ _each year
until I notify you to the contrary.

My Account Number is ... ... ... ... ... ... ... ...
My Bank Sort Code is ... ... - ... ... - ... ... (top right hand corner of your cheques)
Account Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Bank Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Postcode: _ _ _ _ _ _ _ _ _ _
Signed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ _ _ _

To: Lloyds TSB Bank Plc (30-97-62), Pride Hill, Shrewsbury Collection A/C No. 7713427