Membership Application - Couple 3 Years

Couple 3 years – £80

Please complete the form and payment below:

Is this for New Membership or Renewal?
New MembershipRenewal Membership

Title*

First Name*

Last Name*

First Applicant email*

Marketing
Tick box to opt-in to receiving emails advising you of Association and Club events, news and updates
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Phone*

DOB*

Address*
House Name/Number
Street
Town
Postcode

Other adult member in same household

Title

2nd Adult First Name

2nd Adult Last Name

2nd Adult email (if applicable)

2nd Adult Marketing
For joint applications, tick box to opt-in/opt-out to receiving emails advising you of Association and Club events, news and updates.
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2nd Adult Phone

2nd Adult DOB

Additional Junior Member(s) (if applicable)
First Name

Last Name

DOB

First Name

Last Name

DOB

Proposers
Each New Membership application (not renewals) requires a proposer and seconder. However, if you do not know any members to propose you, please submit your application and we will contact you about this.

Proposer

Seconder

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.
I want to Gift Aid*

Full name for Gift Aid

Address for Gift Aid

By clicking on the submit button you agree that
I/We wish to apply for membership to Wythall Community Club.
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.
Data Protection
I Agree with the Privacy policy

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.