Pocklington & District U3A

Membership fee: £10.00 - Year ends 31 March (Cheques payable to: Pocklington & District U3A)

Name (Mr, Mrs, Miss, Ms)  .................Forename:  ................................................................

Surname:  ..............................................................................................................................

Address:  ................................................................................................................................

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

Postcode:  ..............................................................................................................................

Telephone No:  ......................................................................................................................

Email address:  ......................................................................................................................

Which group(s) would you like to join?  .................................................................................

This information will be kept on computer and will not be available to anyone outside the Pocklington & District U3A.  Should any member object to any or all of this information being so kept, it will be removed at their written request.

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Gift Aid Declaration
Registered Charity Number: 1113048

All donations and / or subscriptions I have made since 18th March 2005, and all donations and / or subscriptions I make from the date of this declaration until I notify you otherwise, are Gift Aid donations.

I confirm that 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 appropriate tax year (i.e. 28p for each £1 that you gave up to 5 April 2008 and then 25p for each £1 you give on or after 6th April 2008).
 

Signed:  .......................................................       Date:  ................................................

1. You can cancel this Declaration at any time by notifying the charity.
2. If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax the charity reclaims, you must cancel your declaration.
3. If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
4. Please notify the charity if you change your name and address.

Please print out this application form and send it to:

The Membership Secretary
Fernlea  Main Street
Melbourne
York   YO42 4QE