Full name

Address

Please enroll me as a Friend as indicated below (please put an "x" in the box)

Please pay your subscription in one of the following ways:
(please put an "x" in the box and fill as appropriate)

Now please please print out and sign the gift Aid Declaration below

GIFT AID DECLARATION

All Charitable subscriptions and donations are now eligible for a Tax Refund of 28p for every Pound given. Please sign below in order that the Friends of The Copped Hall Trust may further benefit from your financial support.

TO THE TRUSTEES

I/We wish this sum to be treated as a gift aid donation so that the charity may reclaim the Tax Refund on this and all further donations.

Signature .............................................. Date..........................................................

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STANDING ORDER INSTRUCTION

Your Bank

Full address of your branch

Post code

Name of account holder

Your bank account number

Your bank sort code number

Instructions to the bank

Please pay annually from the account detailed above, the sum of £............... on..................... (date) to the Friends of The Copped Hall Trust, A/C No. 01170775, sort code, 40-30-25, at the HSBC Bank, Loughton, Essex IG10 4LN

Signature

Date