Membership rates:	New member	Life member
	£10.00	£200.00

	I/We wish to apply for membership of the Society and have completed the banker's order form below
Name
Address
Postcode Telephone(inc STD code) & E-mail [optional]
Gift Aid Declaration: I do / do not [delete as applicable] want the charity to treat all donations I have made since 6th April 2000 and all donations I make from the date of this declaration as Gift Aid Donations. I do pay an amount of income tax or capital gains tax equal to the tax reclaimed on my donations and will inform the Society if I cease to pay sufficient tax.
Signed:
Banker's Order: [Do not detach] To: [name & address of your bank, including postcode]
Account Name Bank sort code Account number . . .
Please pay account number 5982 8309 sorting code 09-01-51 of the Somersetshire Coal Canal Society at the Santander Bank the sum of £7.50 / £10.00 on the ....... day of ............month of 20.....and each year thereafter until further notice from my / our account specified above.
Signed
[Delete where applicable. Insert your choice of payment day, month and year - being at least 30 days ahead of the day you dispatch this application.] TO BANK: When making payments please quote SCCS Membership Reference Number: .................................

When completed, please return this form to:
MEMBERSHIP SECRETARY - SCCS
36,Lower Whitelands, Radstock, Bath BA3 3JW
E-mail: membership[at]coalcanal.org.uk  

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