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Become a Patron of the Zoological Society of London

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					                Become a Patron of the Zoological Society of London

I would like to become a ZSL Patron (please select one of the following)

       Partner                 £500 - £1,249 per year
       Guardian                £1,250 - £2,499 per year
       Ambassador              £2,500 - £4,999 per year
       President’s Circle      £5,000 - £9,999 per year

First named adult:
Title ____ First name ______________ Surname ______________ Date of birth __/__/__

Second named adult:
Title ____ First name ______________ Surname ______________ Date of birth __/__/__

Address: _______________________________________________________________
Postcode: ______________________________
Contact telephone: _______________________
Email: _________________________________

Acknowledgement
Please specify by what name(s) you would like to be acknowledged:
_______________________________________
   I would prefer to remain anonymous


Gift aid - make your gift go further
A proportion of your gift represents the commercial value of the benefits you receive as a
Patron and therefore not eligible for Gift Aid.
The remainder of your payment is a donation which may qualify for Gift Aid, which can
increase the value of your support by 25% at no additional cost to you. If you would like
the Society to benefit from this, please complete this section.
To qualify for Gift Aid, you must pay an amount of UK Income Tax and/or Capital Gains
Tax at least equal to the tax that the charity reclaims on your donations in the
appropriate tax year.
If you would like to pay by CAF cheque, please note that only the donation element of
your payment can be made in this way. The balance can be made up by cheque or
credit/debit card. Please contact us for details/advice.
    I would like ZSL to treat this and all my donations from the date of this declaration
until further notice as Gift Aid donations. I will notify ZSL should I change my name,
address or tax status.


Your signature __________________________________                    Date ____/____/____
                                       Payment
                       Please select one of the following options:

    I enclose a cheque for £__________ (please make payable to the Zoological Society of
London)
If you are a US taxpayer and hold a US bank account, you can donate via American Friends of
London Zoo, which is located in Washington DC and receives full tax exemption from the IRS
under section 501(c) (3). Please make your cheque out to American Friends of London Zoo.

   Please charge my credit/debit card (delete as appropriate) with £_________________
Card number
3-digit security number
Issue number (Switch/Solo/Electron)
Start date ____ / ___ / ___ Expiry date ____/ ____/ ____

   I would like to pay by Direct Debit (please complete the instruction below)

Instruction to your bank or building society to pay by Direct Debit
Name and full postal address of your Bank or Building Society:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Postcode: _______________

Name(s) of account holder(s)
______________________________________________________________________
Branch sort code:       -      -
Bank/Building Society account number:

Originator’s identification number: 906369
Reference number (for office use only): ________________________________________

Payment amount: £______________
Payment frequency: Annually until further notice

Instructions to your Bank or Building Society
Please pay the ZSL Direct Debits from the account detailed in this instruction,
subject to the safeguards assured by the Direct Debit Guarantee. I understand
that this instruction may remain with ZSL and, if so, details will be passed
electronically to my Bank/Building Society.

Your signature(s) ______________________________________ Date ____/____/____
Banks and Building Societies may not accept Direct Debit Instructions for some types of account.

                              Please return this form to:
                       Nathalie Bell, Zoological Society of London
                           Regent’s Park, London NW1 4RY
                  Telephone: 020 7449 6406 Email: nathalie.bell@zsl.org

				
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