Please print out and complete this form, then post to the membership secretary

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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
East Sussex
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


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.



Part C Bankers Order

To ______________________________________________ Bank


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 ______________________________


Name __________________________________________

Address __________________________________________

Bank Account Number________________________

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Copyright 2001-19 Sussex Industrial Archaeology Society, Martin B Snow and Contributors - All rights reserved. e&oe
Last modified: January 12, 2019