THE HESWALL SOCIETY MEMBERSHIP
AND GIFT AID FORM

Your membership will include all the members of your family living at the same address.

I (name) ...................................................... am/wish to become a member of THE HESWALL SOCIETY

I would like The Heswall Society to reclaim the tax on my subscription to The Society on all payments that I have made since 6th.April 2000 and may make in the future.

Title ...... Surname .................. Forename(s)......................
Address.............................................................................
................................................. Post Code ......................
Signed .................................................. Date ...................

STANDING ORDER FORM

To the Manager.....................................................Bank
Address........................................................................
................................................... Post Code................

I hereby authorise and request you to debit my/our account No. ........... the sum of £5.00 (Five Pounds) and credit Allied Irish Bank plc Sort Code 23.84.03 for the account of The Heswall Society Account No. 57672072 on receipt of this order and on the 1st.December annually until cancellation; and to cancel any previous standing order payable to The Society.

Name(s) ...................... Account No. ........................
Signed ........................................... Date ...................

Please return this form to: Mrs. Diana Lane, 6 Church Meadow Lane, Heswall, CH60 4SB