Name :
.......................................................................... |
If relevant:
Club or Group:
............................................................ |
Address :
................................................................
................................................................
...............................................................
Postcode :
...................................................................
|
Phone : ....................................
Fax : ..................................
Email : ................................. |
| Tick the box to show your payment: |
Method |
|
Annual
Subscription: |
Individual
£7 |
|
Family
£10 |
|
|
|
Schools
£10 |
|
Movements
£10 |
|
|
|
|
|
Life
£75 |
|
Covenant |
|
|
| Standing Order* |
|
| Cheque** |
|
| Covenant*** |
|
| Cash |
|
|
|
*
**
*** |
Standing
Order - Fill the form below
Cheque - Make cheques payable to 'Dolen Cymru'
Deed of Covenant: If you pay UK income tax, then DOLEN CYMRU, as a
registered charity, can increase the value of your contribution by
claiming back the tax you have already paid on this donation from
the Inland Revenue at the basic rate.Your only commitment is to
a covenant period of four years. |
Return to : Membership
Secretary, Dolen Cymru, 2 Glanrafon, Bangor, Gwynedd LL57 1LH
BANK STANDING ORDER MANDATE
The
Manager: .....................................................
Ltd.
Branch Address :
..............................................................................
..
............................................................................
Postcode :
............................................................
Bank Sort Code : __ __ __ __ __ __
|
Name:
........................................................................
Address :
...................................................................................
....................................................................................
Postcode :
..................................................................
Account Number : _ _ _ _ _ _ _ _ _ _ _ |
To:
HSBC Ltd, Y Maes, Caernarfon, Gwynedd (sort code) i gyfrif rhif Dolen Cymru
Pay Dolen Cymru the sum of £ ......... commencing from ...................
until further notice.
Signed: ..........................................................
Date:
.................................
This
banker’s order replaces/is in addition to any existing banker’s order.
Please amend your
records accordingly.
|