The Derbyshire Ornithological Society

Membership Application Form (please print, complete and send to Barrie Staley, 20 Lancelot Drive, Stretton, Burton-on-Trent, Staffs, DE13 0GJ)

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

 

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

 

First Name:____________________________

 

Last Name:_________________________________________

Address:______________________________________________________

_____________________________________________________________

_____________________________________________________________

Town/City_________________________ County __________________________ Post Code:_______________

E-Mail Address:___________________________________________ Telephone: ___________________

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 Gift Aid help sheet on the HMRC web site
• Please notify us if you change your name or address.

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I would like my DOS Bulletin via post/e-mail (please delete the one that does not apply, if e-mail please make sure you supply your e-mail address above). or more information, you can also E-Mail Barrie. To do so, please

 

Subscription Rates: Adult £12 per annum, Family: £12 per annum, Junior: £5 per annum. (Please note that these will increase to £17 per annum, £17 per annum and £7 per annum for renewals from 1 Jan 2017 onwards). Subscription renewals are due on 1 January each year. If you join after 1 September you will receive free membership until the end of the following year.

 

Data Protection/Privacy: The DOS is registered under the Data Protection Act 1984. The DOS will not pass on any of your details to any other organisation unless required to do so by law, nor will they be used for direct selling purposes. Your details will be held in an electronic membership database and in our Bird Records Database if you send in records

 

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