THE FRIENDS OF

WILTSHIRE CHURCHES

APPLICATION FOR MEMBERSHIP

Surname :

Forename :

Address and Postcode

Telephone :

Email ( if available ) :

Signature :

TYPE OF MEMBERSHIP   Please tick

Individual £ 20 per year    [     ]

Couple £ 30 per year        [     ]

Please complete the Bankers' Order below

and if you are a tax payer the gift aid certificate on the next page.

_______________________________________________________

BANKERS’ ORDER

Name of your Bank:

Bank's Address:

Post Code:

Account Name

Sort Code

Account Number

Please debit this account and pay to:

      Wiltshire Historic Churches Trust - Friends

      Account No.   04376113

      Lloyds TSB Bank Salisbury 30-97-41

The sum of £ ....…….

(In words ……………………………pounds)

Starting from ……………………..…...(date)

and annually until further notice

Signature

Date

Thank you for completing this application form, the banker’s order and the gift aid certificate.

Please now send these to

Michael Hodges

The Friends of Wiltshire Churches

Lawn Cottage  Fonthill Gifford  Tisbury

Wiltshire  SP3 6SG