LogoEXETER CIVIC SOCIETY

Please print this form, complete it and post it to the address shown at the bottom.

Please enrol me as a member of Exeter Civic Society

Mr/Mrs/Miss/Ms ................................................................................................
(BLOCK LETTERS) 

Address................................................................................................................

..............................................................................................................................

..............................................................................................................................

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Postcode ........................................       Tel: ........................................................

 

Membership Subscriptions Please tick
Single Member £6
Family £10
Life MembershipIndividual£78
 Joint£117

 

Please pay your initial or life subscription by cheque to Exeter Civic Society and send it to the address below.

If you wish to pay annually in October by standing order, please indicate this here:            YES / NO

If you are a taxpayer in the UK, please complete the Gift Aid Declaration below. This is an easy way for Exeter Civic Society to increase its income at no additional cost to you.

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Gift Aid Declaration

Details of Donor:

Title ................... Forename(s) ........................................................................... 

Surname ..............................................................................................................

Address................................................................................................................

..............................................................................................................................

..............................................................................................................................

..............................................................................................................................

Postcode ........................................

I want Exeter Civic Society to treat all donations I make from the date of this declaration until I notify you otherwise as Gift Aid Donations. 

Signature ................................................. Date ...................................................

 

 Please note:

Exeter Civic Society is a registered charity, no 286932


Please send your completed form to:

  Stephan Bouloux,
6 Lower Summerlands,
Exeter
EX1 2LJ

Tel: 01392 259626
membership@exetercivicsociety.org.uk