WILTSHIRE BUILDINGS RECORD
Annual Subscription/Subscription Renewal - 1 April 2011
(Individuals £12, Families £15, Organisations £20)
Please return this form to:
Nick Maslen, WBR Membership Secretary, 5 Sunnybank, Corston, Malmesbury, Wiltshire, SN16 0HD
I wish to subscribe to the Wiltshire Buildings Record/I wish to renew my subscription to the Wiltshire Buildings
Record (delete as applicable)
I wish to pay by:
Standing Order (please complete Standing Order form below)
Cheque (please send cheque with form)
I wish to continue with my existing Standing Order
(Please check that it is for the correct amount)
Name: Organisation:
For Organisations, please also give position of contact
Address: Telephone No:
e-mail address:
Gift Aid Declaration – For Individuals wishing to treat their subscription as a Gift Aid donations
Please treat my subscription as Gift Aid
You must pay an amount of income tax and/or capital gains tax in each tax year at least equal to the tax that the
Charity will claim from HM Revenue & Customs on your Gift Aid donation
Signature: .........................................
Please notify the charity if you wish to cancel this declaration, change your name or home address or no longer pay
sufficient tax on your income and/or capital gains.
Tax claimed by the charity:
The charity will reclaim 25p of tax on every £1 you give from 6 April 2009. The Government will pay to the charity an additional 3p on every £1
you give between 6 April 2009 and 5 April 2011. This transitional relief for the charity does not affect your personal tax position.
If you pay income tax at the higher rate, you must include all your Gift Aid donations on your Self Assessment Tax Return if you want to receive
the additional tax relief due to you.
____________________________________________________________________________________________
STANDING ORDER
To: Bank Sort Code:
Address: Account No:
Please pay Wiltshire Buildings Record at Lloyds Bank, Trowbridge (Sort Code 30-98-75, Account No. 02160045) the
sum of £ immediately and then on the first day of April in subsequent years until cancelled by me/us in
writing. This order cancels any previous Order from me/us for payments to WBR
Dated this day of 2010 Signed: Name:
(in block letters)