Please print out and complete this form, then post to the membership
secretary
Application for Membership of the
Sussex Industrial Archaeology Society and Sussex Mills Group
I wish to be enrolled as a member of the Sussex Industrial Archaeology Society
and enciose:
Type of membership required ______________________
*a cheque for the current membership year,
*a Gift Aid Declaration (Part B),
*a Standing Order mandate (Part C),
*Please delete as necessary.
Name ____________________________________________
Address __________________________________________
___________________________________________________
Post Code _________________
Tel. No . ____________________
e-mail ____________________________________________
Special Interests
Any professional or practical skills?
Gift Aid.
To enable the Society to reclaim Income Tax from the Inland Revenue
you are encouraged to complete part B.
When complete, please detach and send to the
Membership Secretary,
Mr P. J. Holtharn
12 St Helens Crescent
HOVE
East Sussex
BN3 8EP
Tel. 01273 413790
In accordance with the Data Protection Act, you are advised that members' names, addresses and telephone numbers are recorded on a computer database. This Information is used to maintain mailing lists and Is not made available to third parties. Under provision of the Act you have the right to object to your details being recorded and should write to the Membership Secretary to that effect
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Gift Aid
Gift Aid (that replaces relief under Deed of Covenant) Is a welcome source of income currently amounting to 28p In the £. Members who pay an amount of Income tax at least equal to the tax the Society can reclaim, are encouraged to complete the gift aid declaration. It can be cancelled at any time and does not require to be witnessed.
Part B Gift Aid Declaration
I (full name in capitals)
of (full Address)
I hereby wish that all annual payments and donations made to the Sussex Industrial Archaeology Society be treated as Gift Aid donations on which the Society as a registered charity may reclaim tax. I affirm that I pay in income tax or capital gains tax an amount equal to or in excess of the amount the Society Is able to reclaim and undertake to inform the Society should such payments to the Inland Revenue fall below this figure or cease. I understand that this declaration can be. cancelled by me at any time.
Signed
Dated
Part C Bankers Order
To ______________________________________________ Bank
Address
Please pay to the account of the SUSSEX INDUSTRIAL ARCHAEOLOGY SOCIETY
at HSBC plc, 1 Warwick Street Worthing, West Sussex BN 11 3DE
(A/c No. 61345680) on April 1st each year until further notice
and debit my account the sum of :
__________________________________________ (£ ________________)
Signed ______________________________
Date__________________
Name __________________________________________
Address __________________________________________
Bank Account Number________________________
