The H&G Canal Trust Membership Form
Please print your answers
Name:
Address:

 

 

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gift card:
Postcode:
Telephone:
Details, please, of any skills that might assist us in
our work:

 
Please tick category of membership required
UK rates Annual Life

Donation:
Please help us to keep
our subscriptions low
and accelerate our
restoration progress
by making a donation

Donation £................
Individual

£7.50 box.gif (856 bytes)

£150 box.gif (856 bytes)
Joint/Family

£10 box.gif (856 bytes)

£200 box.gif (856 bytes)
Senior Citizen

£5 box.gif (856 bytes)

£80 box.gif (856 bytes)
Joint Senior Citizen

£7 box.gif (856 bytes)

£110 box.gif (856 bytes)
Corporate

£20 box.gif (856 bytes)

£400 box.gif (856 bytes)

For EC add £2.50/£50; for rest of the world add £5.00/£75

Total

    £..................
Bankers OrderTo:
(name and address of your bank)
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Please pay to account No. 11600694, sorting code No. 16 21 20 of the
Herefordshire and Gloucestershire Canal Trust at the Royal Bank of
Scotland, 21 Broad Street, Hereford, HR4 9AP

The sum of £……………..on this day and thereafter, annually (on the anniversary) until further notice.

My account No………………………….. Date………………………

                                             Signed……………………………………… 

This instruction CANCELS any previous Bankers Order in favour of the Trust or the former Society.
Please return the completed form to:
The Membership Secretary, Herefordshire & Gloucestershire Canal Trust, 6 Castle St, Hereford, HR1 2NL

  

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