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I apply for membership of LUPUS UK and enclose my cheque/p.o. payable to LUPUS UK
Title: Mr. Ms. Mrs ................... First name .........................................................
Surname:................................................... Membership fee: £...........
Address:.................................................... (plus donation if wished, thank you)
................................................................. £...........
................................................................. Total:£...........
Postcode: ....................................... Tel:............................................................
Annual Rates
Single membership...................................... £10 pa
Double membership**.................................. £15 pa
Single overseas membership........................ £14 pa
Double overseas membership**.................... £19 pa
**both at same address
GIFT AID DECLARATION
I wish LUPUS UK to treat any membership fees / donations made by myself as Gift Aid donations.
Signature..........................................................................................
Date......................................................
I confirm I pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on my donations in the tax year (currently 25p per £1, plus a Government supplement of 3p per £1 until 5th April 2011)
I would also be interested in Volunteering Opportunities for LUPUS UK and/or my Regional Group
(please tick)
IF WISHING TO REMIT BY STANDING ORDER, PLEASE TELEPHONE FOR THE INSTRUCTION FORM
PLEASE COMPLETE RELEVANT SECTIONS OF THIS FORM AND SEND TO:
LUPUS UK, St James House, Eastern Road, Romford, Essex RM1 3NH
Tel: 01708 731251 Fax: 01708 731252 |