Epping Forest Centenary Trust Charity Registered No For the

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					1878
  -
1978
                             Epping Forest Centenary Trust                                                  The Warren Lodge
                                                                                                            Loughton
                             Charity Registered No 275076
                                                                                                            Essex IG10 4RN
                                                                                                            Tel/fax: 020 8508 9061
                                                                                                            Email: office@efct.info
                                           Associate Membership Form                                        Website: www.efct.info
                                       For the period 1 January to 31 December 2008

       Name     …………………………………………………………………
                …………………………………………………………………
       Address & Postcode
       ………………………………………………………………………………………..
       Please tick relevant boxes
                A cheque
                CAF Voucher
                Cash
                Standing Order Form
       For
                £15 single membership
                £25 family membership
                £50 group membership
              £………. Any other amount
       Any amount is always gratefully received towards our work in bringing Epping Forest to London’s
       disadvantaged children
                I already pay by standing order
                I would like to pay by standing order


                £1.50 per month for single membership and
                £2.50 per month for family membership

                                               Gift Aid - Taxpayers Declaration
       I declare that all donations and subscriptions received from me by the Epping Forest Centenary Trust from 6th April
       2006 until further notice are to be treated as Gift Aid and that UK income tax may be accordingly reclaimed. I also
       declare that I have paid an amount of UK income or capital gains tax at least equal to that deducted from my
       donations and shall inform Epping Forest Centenary Trust whenever I have ceased to pay UK income or capital
       gains tax to that extent.

       Signature: ………………………… Name in capitals: ……………………..………………Date…………….




         Standing Order form

         To (name of bank) ……………………………………………………………………………
         My Bank Address and Postcode ………………………………………………………………
         ……………………………………………………………………………………………….
         My Account Name        …………………………………………………………………………
         My Account Number …………………………………………………………………………
         Please debit my account with £ …….……………………………………… [in words] monthly
         The first payment to be made on or as soon as possible after ………………………… (date)
         PAYEE: CAF Bank Sort Code 40-52-40 Account No 00000032 Epping Forest Centenary Trust

         Signature of account holder …………………………                                      Date ……………………



                                                 Directors: Terence Mallinson CBE, DL, MA (Chairman);
               Judy Adams MIEEM, MILAM; TL Barker LLB; JI Besent OBE, FRICS; JL Bird OBE, FCA; RS Morris, OBE; KMR Foster FCA;
                   Company limited in England by guarantee No.1339783. Registered office: The Warren Lodge, Loughton, Essex IG10 4RN