The Derbyshire Ornithological Society

Membership Application Form (please print, complete and send to the address below)

Membership Type (tick one): Adult ___ Family ___ Junior ___

Title: Mr/Mrs/Ms/Dr    Other (please specify): ______

First Name:____________________________

Last Name:_________________________________________

Address:______________________________________________________

_____________________________________________________________

_____________________________________________________________

Town/City_________________________ Post Code(UK):_______________

E-Mail Address:_____________________________

Date ___/___/___

Please make cheques payable to: The Derbyshire Ornithological Society

Tick here if you want the DOS to treat your subscription and all subscriptions you make from the date of this declaration, until you notify otherwise, as Gift Aid donations.

You must pay an amount of Income Tax and/or Capital Gains Tax at least equal to the tax that the DOS reclaims on your subscriptions in the appropriate tax year.

Notes:

• You can cancel this Declaration at any time by notifying us at the address below.
• If in the future your circumstances change and you no longer pay tax on your income and capital gains equal to the tax that the charity reclaims, you can cancel your declaration.
• If you pay tax at the higher rate you can claim further tax relief in your Self Assessment tax return.
• If you are unsure whether your donations qualify for Gift Aid tax relief, contact us at the address below, or refer to help sheet IR65 on the HMRC web site.
• Please notify us if you change your name or address.