MEMBERSHIP APPLICATION FORM To: The Secretary, Nottinghamshire Building Preservation Trust Limited, Minster Chambers, Church Street, SOUTHWELL, Nottinghamshire, NG25 0HD I/we wish to become: An Ordinary Member/Ordinary Members - £15.00 per annum (£25.00 for couples) Concessions/Child Members - £10.00 per annum Family Members (2 adults & 2 or more children) - £30.00 per annum Corporate Members (Institutions & Businesses) - £25.00 per annum and I/we enclose my/our subscription of £.................................................................. Name (Block Letters)........................................................................................................................................................................................................................... Address............................................................................................................................................................................................................................................ Signed................................................................................................................. Date.................................................................................................................... If you have a Bank Account, please use the attached Banker's Standing Order Form. It really does help to simplify our book-keeping. Thank you. If you are a Taxpayer please complete the attached Gift Aid Declaration. We can increase the value of your subscriptions significantly at no extra cost to yourself, simply by completing and returning the form attached. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- THE NOTTINGHAMSHIRE BUILDING PRESERVATION TRUST LIMITED. STANDING ORDER INSTRUCTIONS. To the Manager........................................................................................................................*Bank.......................................................................................................*Branch ..................................................................................................................................................................................................................................................*Address Please pay now/1st April 2008* (please delete which is appropriate), and on 1st April each succeeding year,until you receive further notice from me/us in writing, to the NatWest, 52 Rectory Road, West Bridgford, Nottingham, NG2 6FF, for the credit of the Nottinghamshire Building Preservation Trust Limited (Account Number 04149807) the sum of £......................................* (amount in figures).................................................................................................................................*(amount in words). Account Number..................................................................* Signed......................................................................................................* Name (Block Capitals)........................................................................................................................................................................*Date..............................................................................* ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- GIFT AID DECLARATION. I wish the Nottinghamshire Building Preservation Trust Limited to treat as Gift Aid Donations all donations and subscriptions I have made since 6 April 2000 and all donations and subscriptions I make in future, unless notified otherwise. Name..........................................................................................................................* Address........................................................................................................................................................................................................................................................................* Signed..................................................................................................* Date.................................................................................* This Declaration is only valid if you pay an amount of income tax at least equal to the amount of your subscription. You must notify the NBPT Limited if your circumstances change. * Please complete the details fully and forward to the NBPT with your application Form. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- last updated: 17th November, 2007