Associate Membership

Associate Membership Applications

If you would like to support the Association by becoming a member please complete the short application form below. Please complete a form and payment for each individual application.

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- Step 1 of 5

Is this for New Membership or Renewal? *

• Renewal Membership
• New Membership

Number of Adult Members *

• One Adult
• Two Adults

Adult Member

Title *---Select Title---MrMrsMissMsMxSirDameDrProfCllrLadyLord

Adult Member *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Email *

Phone *

Date of Birth *

Example - 22/09/2003

Marketing *

• Opt-in
• Opt-out

Opt-in to receiving emails advising you of Association and Club events, news and updates.

Next

Additional Adult Member

Title *---Select Title---MrMrsMissMsMxSirDameDrProfCllrLadyLord

Name *

First

Last

Email

Phone

Date of Birth *

Example - 22/09/2003

Marketing *

• Opt-in
• Opt-out

Opt-in to receiving emails advising you of Association and Club events, news and updates.

Next

Junior Members

Members under 18 years old are FREE to join.

Are there additional Junior Members (<18s)? *

• Yes
• No

First Junior Member

First

Last

Date of Birth

Example - 22/09/2003

Second Junior Member

First

Last

Date of Birth

Example - 22/09/2003

Next

Proposers

Proposer One

First

Last

Address or Membership Number

Proposer Two

First

Last

Address or Membership Number

Next

Subscriptions

Subscription fees are determined by the subscription type and the number of members of each subscription type.

Individual Subscriptions *Adult 1 Year - Association & Club - £15.00Adult 3 Years - Association & Club - £40.00Adult (65+) - 1 Year - Association & Club - £13.00Adult (65+) 3 Years - Association & Club - £36.00Adult 1 Year - Association Only (Excludes Club) - £10.00Adult (65+) - 1 Year - Association Only (Excludes Club) - £10.00

Please note: 'Association Only' Excludes membership to the Club.

Couple Subscriptions *Couple 1 Year - Association & Club - £30.00Couple 3 Years - Association & Club - £80.00Couple, one over 65 - 1 Year - Association & Club - £28.00Couple, one over 65 - 3 Year - Association & Club - £76.00Couple, both over 65 - 1 Year - Association & Club - £26.00Couple, both over 65 - 3 Years - Association & Club - £72.00Couple 1 Year - Association Only (Excludes Club) - £20.00

Please note: 'Association Only' Excludes membership to the Club.

Voluntary additional charity donationDonation - £5.000123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100

We aim to keep our fee rates as low as possible but, if you can spare a little more to help the charitable work of Wythall Community Association, it would be greatly appreciated.

Total

£0.00

Giftaid It

Gift Aid allows us to reclaim 25p on every £1 of your subscription that you give to Wythall Community Association and additional donations. Please state that you are happy to do this by declaring here:

I want to Gift Aid the element of the total subscription due to Wythall Community Association, any donation and any similar payments I make in the future. I am a UK taxpayer and understand that if I pay less Income Tax and / or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that year, it is my responsibility to pay any difference.

Please remember to let us know if you wish to cancel the declaration, are no longer a UK taxpayer or pay insufficient tax.

Giftaid Consent

• I want to Giftaid It

Giftaid Name *

First

Last

Let us know if it's the Adult Member or Additional Adult Member who can Giftaid.

Why would you like to join?

Please help us by telling us your reason for joining or where you heard about us.

Membership Agreement *

• I/We Agree

I / We wish to apply for membership.

Where applying for Club membership, I / We agree to abide by the Rules of The Club.

Data Protection - Privacy Policy

All information submitted here is for internal use only and will never be shared with other organisations. Instructions on how to opt-out of our email distribution list are included in every email sent out. Please tick the checkbox that you have read and agree with our privacy policy.

Stripe Credit Card *

Submit

Gift Aid

• • • Your donation could be worth even more to the Wythall Community Association through the Gift Aid scheme. Ticking the Gift Aid box on the application form means we can reclaim tax for every £1 you give. To qualify you must pay an amount of income tax and / or capital gains tax at least equal to the tax that the charity reclaims on your donations in the tax year.
    • Please complete all your details clearly above and, if applicable, sign to allow us to claim Gift Aid on your donation.
    • You agree that the element of £10 per person per annum due to Wythall Community Association (Registered Charity No. 243332) and any similar payments you make in future, may be used to claim Gift Aid.
    • Funds raised will go towards the charitable and public benefits.
    • We will share required details, such as your name, first line of address, postcode and age with HMRC as required to claim the Gift Aid.