Title

Member Name

First Name

Last Name

Member email

Phone number

Member phone number

Address

House Number / Name

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gift Aid

The Parkgate Society can benefit from the Gift Aid Scheme if you pay UK income or capital gains tax. We can reclaim the tax on your membership subscription or donation: for every £1 you give, we can claim an extra 25p from the Inland Revenue.

Do you consent to Gift Aid your subscriptions and donations now and in the future?

Date