Membership Form

Once you complete the form below, we will contact you with details on how to pay via BACS. Your new membership will come into effect as soon as your payment has been received and your details have been verified by our team. We will keep you fully informed by email throughout this process.

Membership Categories

Single Adult Membership - £15 Joint Membership - £25 Young (U18) Membership - £5 Family Membership - add £5 per child (U18) to any other Adult Membership type Lifetime Membership - £200

Adult (or Parent / Guardian)

Name

Address 1

Address 2

Town / City

County

Postcode

Telephone / Mobile Number

Email Address

2nd Adult (or Parent / Guardian)

Name

Address 1

Address 2

Town / City

County

Postcode

Telephone / Mobile Number

Email Address

Youth / Family

Child #1

Date of Birth

Child #2

Date of Birth

Child #3

Date of Birth

Child #4

Date of Birth

It won’t cost you a penny more but it’s worth 25% more to the Friends if you tick the box below:

Please claim Gift Aid on my membership and all my donations now and in the future.

I confirm that I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the Charities to which I donate will reclaim on my gifts for that tax year. I understand that other taxes such as VAT or Council Tax do not qualify. I understand that the Charity will reclaim 25p of tax on every £1 that I give.

Please tell us if you want to cancel this declaration, change your name or home address, or you no longer pay sufficient tax.

Payment

Thank you! Before we can activate your membership, we will send you details on how to pay by BACs. As soon as your payment has been received, your membership will be activated.

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Alfred East Art Gallery

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