Membership Information Form

Complete this form to join as a member of Wiltshire Wildlife Trust. Prices for membership are below;
Individual - £2.50 per month
Joint - £3.00 per month
Family - £4.00 per month
Wildlife Watch (child) - £15 annually

About you:

Title: *

If other, please give details here:

First Name: *

Last Name: *

Telephone Number: *

Mobile:

Email Address: *

Date of Birth:

Address Line 1: *

Address Line 2:

Town: *

County:

Postcode: *

Type of Membership: *

I have chosen to pay by: *

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.

Email: *

YesNo

Post: *

YesNo

Phone: *

YesNo

Details of additional adult if joint or family membership:

Adult 2 Title:

If other, please give title here:

Adult 2 First Name:

Adult 2 Last Name:

Adult 2 Date of Birth

Details of child(ren) for Family membership or Child Only Watch:

Child 1 First Name:

Child 1 Last Name (if different from adult):

Child 1 Gender:

Child 1 Date of Birth:

Child 2 First Name:

Child 2 Last Name (if different from adult):

Child 2 Gender:

Child 2 Date of Birth:

Child 3 First Name:

Child 3 Last Name (if different from adult):

Child 3 Gender:

Child 3 Date of Birth:

Child 4 First Name:

Child 4 Last Name (if different from adult):

Child 4 Gender:

Child 4 date of Birth:

Send