Last modified:14th November, 2006
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MEMBERSHIP FORM

The Society of the Friends of Milton's Cottage
Title...............Forename(s)......................... Surname...............................
Address.....................................................
.....................................................
.....................................................Post Code...................................
eMail...................................................................................
Phone......................................................................................

I enclose a Standing Order/ Cheque/ International Money Order

GIFT AID DECLARATION

(Delete this paragraph if it is not applicable.) I wish The Society of the Friends of Milton's Cottage to treat this donation, and any future donation that I may make, as Gift Aid donations. I confirm that I pay income tax or capital gains tax at least equal to the tax deducted from this and any future donations.
Signature........................................
Date......../......../............
Complete the Membership Form and Standing Order form (if applicable) and send them to:
The Treasurer, Friends of Milton's Cottage,
Milton's Cottage, Deanway,
Chalfont Saint Giles, Buckinghamshire HP8 4JH
Existing Friend £12
New Friend single adult membership £24
New Friend joint adult membership £36
Benefactor £84
Life Member Please write to the Treasurer

STANDING ORDER

The Society of the Friends of Milton's Cottage - Charity Number 274269

To The Manager,(name of Bank)......................................, (Bank address).............................., ............................................, ............................................, post code......................................... Sort Code ...... - ...... - ......
Please debit my account number ......................
the sum of £.............
now and (delete which is not applicable) monthly/annually hereafter
and pay the Society of the Friends of Milton's Cottage, NatWest Bank PLC, Chalfont St Peter, sort code 60-05-50 account number 03606708
Signature........................................
Date...../...../.....