Alzheimers Society membership leaflet

6 Getting support in your area You can choose to become a member of your local Alzheimer’s Society branch. We have over 230 local branches in England, Wales and Northern Ireland. I I would like to become a member of the closest branch to where I live I I would like to become a member of the following branch (if known) ‘When I joined Alzheimer’s Society I found the support I needed to live my life again.’ Alzheimer’s Society Dementia Helpline For information, support and confidential guidance, speak to trained advisers I I do not wish to become a member of a local Alzheimer’s Society branch at present Data Protection Alzheimer’s Society will not pass your details on to any other organisation. We may use your information to contact you in the future (including by telephone) about Alzheimer’s Society’s activities, including fundraising. If you would prefer not to receive communication from us, other than communication about your membership, please let us know by contacting us. England and Wales 0845 3000 336 8.30am - 6.30pm Monday to Friday Northern Ireland 028 9066 4100 9.00am - 5.00pm Monday to Friday How to join Simply fill in the parts of the form that apply to you and send it back to us. If you have any questions, call membership enquiries on 0845 306 0868. Membership Enquiries 0845 306 0868 membership@alzheimers.org.uk Alzheimer’s Society Devon House 58 St Katharine’s Way London E1W 1JX hank you t alzheimers.org.uk Registered charity no. 296645. A company limited by guarantee and registered in England no. 2115499 ‘ Thank you for the good work you are doing. And, thanks to our local group who give such hope and pleasure to carers, by providing lunches and outings. It is a life-saver, I’m sure. ’ MSWEB Carer and Alzheimer’s Society Member alzheimers.org.uk You don’t have to cope alone. We’re here to help. Once you join Alzheimer’s Society you become part of a powerful network of support. You’ll find there is always someone to turn to, whatever help and advice you need. I would like to become a member of Alzheimer’s Society 1 Your details Title Surname Address First name 4 Direct Debit Originator’s identification number: 648888 INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT (Please complete using a ballpoint pen) FOR ALZHEIMER’S SOCIETY OFFICIAL USE ONLY. This is not part of the instruction to your Bank or Building Society. This section to be completed by the payer: I would like to pay my membership subscription by Direct Debit for the amount of: £ : Each Month / Quarter / Year* Starting on: 1st/8th/15th/22nd* of Name(s) of account holder(s): *delete as appropriate Why become a member? I You will regularly receive all our latest news and updates on progress being made in dementia related research I We’ll signpost you to your local branch, which can offer practical support, advice and contact with people in a similar situation to you I Each month you will receive our magazine, Living with dementia I We’ll alert you to helpful fact sheets from our website, with information on all aspects of dementia I You will receive our publications catalogue and cards and gifts catalogue I Our Dementia Helpline offers confidential support and guidance from trained advisers Your membership will also help ensure we are there for people fighting dementia now - and that we continue in the search for a cure that will defeat dementia in the future. Postcode Telephone Email Date of birth if under 18 years of age: (Month) (Year) Bank/Building Society account number: Branch sort code: Please tick whichever box describes you most closely: I I have dementia I am caring for a relative/friend with dementia: I at home I in residential/nursing care I am: I a concerned relative/friend I a former carer I a professional I interested IIIIIIII To the Manager Address: Bank/Building Society: II-II-II Name and full postal address of your Bank or Building Society: Postcode: 2 Your subscription amount There is no fixed annual subscription, but please give generously to help our work. If you have dementia or are caring for a relative/friend with dementia and would like free membership, please tick here I I enclose a subscription of I £10 I £15 I £25 I £50 I Other: £ Banks and Building Societies may not accept Direct Debit instructions for some types of account. Instructions to your Bank or Building Society: Please pay Alzheimer’s Society, 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 Alzheimer’s Society and, if so, details will be passed electronically to my Bank/Building Society. Signature(s) of account holder(s): X 5 Maestro only Date 3 Payment method I I would like to pay by Direct Debit (helps keeps costs down - see next page) I I enclose a cheque payable to Alzheimer’s Society I I would like to pay by Visa/Mastercard/Maestro/CAF card no: Make your gift worth more at no extra cost IIII IIII IIII IIII III Maestro only Membership Enquiries 0845 306 0868 Expiry Date Signature / Issue Date / Date Issue no. I I am happy for all gifts of money that I have made to Alzheimer's Society in the past 6 years and all future gifts of money that I make to be Gift Aid donations. You must pay an amount of income tax and/or capital gains tax in each tax year at least equal to the tax that we will claim from HM Revenue & Customs on your Gift Aid donation(s). Alzheimer's Society will reclaim 28p of tax on every £1 you gave up to 5 April 2008 and 25p of tax on every £1 you give on or after 6 April 2008. The Government will pay Alzheimer's Society an additional 3p on every £1 you give between 6 April 2008 & 5 April 2011. Please return the form to: FREEPOST RRRL-JRJB-YCSX, Alzheimer’s Society, Devon House, 58 St Katharine’s Way, London E1W 1LB MSWEB Registered charity no 296645. A company limited by guarantee and registered in England no. 2115499.