Please complete thisn form and send it with a cheque to cover your first year's subscription to:

(If you opt to pay future subscriptions by Standing Order you may also pay your first year subscription by this method - please see below)

If you wish to pay your subscriptions by Standing Order please complete all sections of the Mandate and forward it to:

You should write your surname and initials in the reference box,the sum payable in figures after the £ sign and the sum payable in words within the brackets which follow the £ sign.

After the word ‚commencing™ please enter either the date of your

membership application or, if you are paying your first year™s

subscription by cheque, 1 October followed by the relevant year.

*UDQW$LG'HFODUDWLRQ Completion and submission of this form will enable the Society to

claim the refund of UK taxes which you will pay on the amount of

your subscriptions and donations if and when the Society is

registered as a Charity. If you decide to make this declaration it

should be returned to the Society™s Hon. Secretary with your

membership application form. NB: You do not need to sign the

Grant Aid Declaration.

To:

The Hon. Secretary, Fussells Iron Industry Society

Please enrol me as a member of the Fussells Iron Industry Society

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Cheques should be made payable to )XVVHOOV,URQ,QGXVWU\6RFLHW\

I understand that my details may be held on a computer database for the purposes of the administration of the Society and that my name and

address will, unless I request otherwise, be included in any membership list issued to members from time to time

To ..........................................................Bank 67$1',1*25'(50$1'$7(

Postal Address .................................................................................................................

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Banks may decline to accept instructions to charge Standing Orders to certain types of account other than Current Accounts

Signature(s) ......................................................................................................

...................................................................................................... Date ................................

Please pay /OR\GV76%)URPH6RPHUVHW [Sorting Code Number � ] for the

credit of )XVVHOOV,URQ,QGXVWU\6RFLHW\ [Account Number � ] quoting

reference the sum of &endash; [ only]

commencing and thereafter HYHU\2FWREHU until further

notice in writing and debit my/our account accordingly.

PLEASE CANCEL ALL PREVIOUS STANDING ORDER/DIRECT DEBITING

MANDATES IN FAVOUR OF FUSSELLS IRON INDUSTRY SOCIETY

Account Number:

Bank Sort Code:

Name of account to be debited:

 

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*,)7$,''(&/$5$7,21 It is intended that the Fussells Iron Industry Society shall be

registered as a Charity. By completing the declaration below you

will empower the Society, if and when it becomes a registered

Charity, to claim the refund of UK taxes which you will pay on

your subscriptions and donations from the date chosen. This

declaration will be kept as a record until cancelled.

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I want the charity to treat all donations (including membership

subscriptions) from this date until further notice as Gift Aid

donations.

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Please remember to notify the Treasurer if you no longer pay

Income or Capital Gains Tax equal to the tax which the Fussells

Iron Industry Society will reclaim on your donations.

Donors are entitled to cancel their declarations at any time by any

form of communication. No claims for tax refunds in the name of

that donor may be made from the recorded date of the cancellation.