Individual Membership form

Is this a gift membership? If yes, please put details of recipient below - if not, please continue to the “about you” section *

Yes, this is a gift membershipNo, this is for myself

Optional gift message

Would you like the gift membership to be sent to the recipient directly or to you first? *

Yes, please send to me firstNo, please send directly to the recipient

If yes, please put the details of the recipient

About you

Title *

MrMrsMissMsDrOther

If other, please state

First name *

Last name *

Telephone number *

Mobile *

Email address *

Date of birth *

Gender:

Address line 1 *

Address line 2

Town *

County *

Post code *

GIFT AID: By selecting the ’I agree to Gift Aid’ option below you agree to the following statement: I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I have given.

*Gift Aid Declaration *

I agree to Gift AidI am not a UK tax payerI do not wish to Gift Aid

Respecting your privacy: Wiltshire Wildlife Trust is registered as a Data Controller with the Information Commissioner. The information you provide to us will be held on our systems for the purpose of administering your membership including membership mailings and to provide you with information about our work and appeals that are of interest to you. This information will be solely used by Wiltshire Wildlife Trust and we do not give or sell details of our members to any third party. You may change your preferences at any time by contacting us.

Please select from the options below if you agree to be contacted by Wiltshire Wildlife Trust:

Email *

Phone *

Post *

By clicking the button below, you will be redirected to another page to make your payment. Please ensure you have filled in all of your details before doing so, and note that membership will not be valid until the payment has been successful.