I wish to become an Annual/Double/Life/Joint Life member of The Friends of Coleridge.
I am a UK / European / World / Member
(See previous page for rates)
Name ............................................. Address.......................................................
...................................................................
.....................................................................
E-Mail:
.................................................
Telephone:..................................................
I enclose £.................................... Please make cheques (in UK sterling only) payable to The Friends of Coleridge.
(Overseas members are particularly recommended to pay using the online procedure:
this is the cheapest and securest way of transferring small sums internationally.)
GIFT AID (for UK Taxpayers: delete if not applicable) I declare that this payment made by me and any
further donation I may make in the future should be treated as Gift Aid donations. I will have paid an
amount of Income Tax or Capital Gains Tax equal to the tax The Friends of Coleridge (U.K. Registered
Charity No. 295285)
Signed:
..............................................................
Date: ................................................
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Standing Order
To the Manager
Bank
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..
.
Postcode
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.
Please pay to The Friends of Coleridge
Sort Code: 20-85-26 Account No:40390100 Barclays
Bank, 16 High Street, Bridgwater
The sum of £
. now, and annually each year on 15 January
until further notice.
Signed:
..............................................................
Date: ................................................
Account Name:
......................
Number
My
Address
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Please print out this page and send the completed form with your cheque to
Justin Shepherd, Membership Secretary, The Coach House, Ford, Wiveliscombe,
Taunton, TA4 2RJ, England