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INDIVIDUAL MEMBERSHIP RENEWAL FORM - DOC

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					INDIVIDUAL MEMBERSHIP RENEWAL FORM 2010
Please complete the Application Form and other forms and return it along with payment to:
Membership Department, Chatham House, FREEPOST LON17463, (10 St James Square) London,
SW1Y 4LE

Please tick the appropriate box
        Full Membership for £240 (£220 by direct debit)
        Under 35s Membership for £140 (£120 by direct debit)
        Web Membership for £80 (£75 by direct debit)

Update Your Contact Details:
Membership Number:

Title (Mr/Mrs/Ms/Dr/Other):                        Full Name:

Nationality:                                       Date of Birth (DD/MM/YY):

Home Address:
                                                   Postcode:

Home Email:                                        Home Tel:

Work Email:                                        Work Tel:

Job Title:

Organisation (and address):
                                                   (Our membership database is subject to the Data Protection Act)
Other Information:

        I have completed a gift aid form
        I have updated my interests using the Interests Questionnaire Form enclosed


Payment Method:

        I enclose my credit / debit card details
Name (as it appears on debit/credit card)
Card Number:

Card Issuer:                                       Issue Number:

Start Date:                                        Expiry Date:

Security Code (on signature side of card):


        I enclose a cheque (made payable to “Chatham House”)

        I enclose a direct debit form (we must receive the original form by post)
    Please fill in the whole form except the
    Reference/Sequence number and Chatham                              Instruction to your Bank or
    House membership number using a ball point
    pen and send it to:
                                                                       Building Society to pay by
                                                                       Direct Debit
     The Royal Institute of International Affairs
                                                                       Originators Identification Number
     Chatham House
                                                                           9|9|8|4|9|0
     10 St James’s Square

     London                                                                    Reference/Sequence number
    Name(s) of Account holders to be debited                                   (For office use only)
     SW1Y 4LE

                                                            .
                                                                       Full name

    Bank/Building society number                                       .                                                                .

               |    |    |      |   |    |    |                        Chatham House membership number
                                                                       .                                                                .
    Branch Sort Code

               |    |    |      |   |
                                                                       Instruction to your bank or Building Society
                                                                       Please pay Royal Institute of International Affairs Direct Debits
    Name and full post code of Your Bank or                            from the account detailed in this Instruction subject to the
    Building Society                                                   safeguards assured by the Direct Debit Guarantee. I understand that
                                                                       this instruction will remain with (RIIA) and, if so details will be
To: The Manager              Bank/Building Society                     passed electronically to my Bank/Building Society.

.                                                    .                     Signature(s)
Address
                                                                           .                                                                    .
.                                                    .


.                                                    .                     .                                                                .
Postcode                                                                   Date



           Banks and Building Societies may not accept Direct Debit instructions for some types of Account

          This guarantee should be detached and retained by the Payer


                                                                      The
                                                                  Direct Debit
                                                                  Guarantee
          This Guarantee is offered by all banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of
           the Scheme is monitored and protected by your own Bank or Building Society.
          If the amount to be paid or he payment dates change RIIA will notify you 10 working days in advance of your account being debited
           or as otherwise agreed.
          If an error is made by RIIA or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the
           amount paid.
          You can cancel a direct debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.
INTERESTS QUESTIONNAIRE
If you would like to update your interests you gave us when you first joined.

The information you provide us will enable us to invite you to additional events, arranged at
short notice, concerning your specific interests.




SECTION A – THEMES                   SECTION B – REGIONS

□ RESOURCE GOVERNANCE                                □ AFRICA
□ ENERGY                                             □ AMERICAS
□ ENVIRONMENT                                        □ ASIA
□ GLOBAL HEALTH                                      □ EAST ASIA
□ INTERNATIONAL ECONOMICS                            □ SOUTH ASIA
□ INTERNATIONAL INSTITUTIONS                         □ EUROPE
   (E.g. IMF, UN, WORLD BANK)

□ INTERNATIONAL LAW                                  □ MIDDLE EAST
□ INTERNATIONAL SECURITY                             □ RUSSIA AND EURASIA
Chatham House
10 St James's Square
London
SW1Y 4LE

GIFT AID DECLARATION

Gift Aid donations made by UK taxpayers* allow Chatham House to reclaim 25p from the
Inland Revenue for every £1 donated (representing 20% basic rate tax). In addition, if you are
a higher rate taxpayer, you may reclaim 20% (the difference between the basic and higher
rates of tax) of the total value of the gift in your Self-Assessment return. Membership
subscriptions to Chatham House count as donations for this purpose (except subscriptions
paid by a 3rd party on behalf of a member).

I would like Chatham House to treat all subscriptions and donations I have made for the 6
years prior to this year and all subscriptions and donations I shall make from the date of this
declaration as Gift Aid donations until I notify you otherwise.

□       I am a UK taxpayer                  □       I am not a UK taxpayer


Name:                  …………………………………………………………………………..

Signed:                …………………………………………………………………………..

Date:                  ……………………………………………………………………………

Membership No.:        ……………………………………………………………………………

PLEASE FILL IN THE BOX BELOW WITH YOUR HOME ADDRESS




THANK YOU FOR SUPPORTING CHATHAM HOUSE

*       You must pay an amount of income tax or capital gains tax at least equal to the tax
        that Chatham House reclaims on your donations in the appropriate tax year (currently
        25p for each £1 you give). You can count tax paid on your dividend income. If in
        future your circumstances change and you no longer pay tax on your income and
        capital gains equal to the tax that Chatham House reclaims, you can cancel your
        declaration.

				
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