PLEASE PRINT OUT AND FILL THIS IN, AND SEND IT TO THE ADDRESS AT THE BOTTOM
Name(s)……………………………………………..
Your contact details:
……………………………………………………………………………………………
I’d like to join or renew my membership (please circle category)
Friend £15/year
Supporter £25/year
Patron* £75/year
Benefactor* £150/ (or more)year
*Patrons and benefactors are entitled to 2 free tickets to the Layer Marney concert
□ I’ve completed the standing order form below
□ I enclose a cheque for this year’s membership. Please make payable to Roman River Music and send to Zélie Jopling, South Green Farmhouse, Fingringhoe, CO5 7DP.
□ I am a UK taxpayer and would like to treat all donations I have made for the six years prior to this date, and all donations I make hereafter, as Gift Aid donations. I understand that I must pay an amount of income tax and/or capital gains tax in each tax year at least equal to the tax that Roman River Music will claim from HM Revenue & Customs on my donations.
Signature……………………………………… Date…………………………………
Standing order authority (WE WILL FORWARD THIS TO YOUR BANK)
To: The Manager, …………………………………………………………………………(name of your bank)
Address: …………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
Post Code …………………………………………….
Branch Sort Code ………/………../………. Account Number………………………………………
Account Name………………………………………………………………………………………………………………..
Please pay the sum of £……………… (words)…………………………………………………………………..
To: Alliance & Leicester Commercial Bank, Bridle Road, Bootle, Merseyside G1R 0AA
for the credit of Roman River Music Account no: 25 37 20 83 Sort Code: 72 00 05
from the account detailed above, on the same day each year (commencing: date………, month………, year………) until further notice.
Signed………………………………………………………… Date…………………………………………………
