Membership rates:	Family Individual	Senior citizen Student	Life Membership
	£7.50	£5.00	£150 or 4 annual payments of £37.50

	I/We wish to apply for membership of the Society and have completed the banker's order form below
Name
Address
Postcode Telephone(inc STD code) & E-mail [optional]
Gift Aid Declaration: I do / do not [delete as applicable] want the charity to treat all donations I have made since 6th April 2000 and all donations I make from the date of this declaration as Gift Aid Donations. I do pay an amount of income tax or capital gains tax equal to the tax reclaimed on my donations and will inform the Society if I cease to pay sufficient tax.
Signed:
Banker's Order: [Do not detach] To: [name & address of your bank, including postcode]
Account Name Bank sort code Account number . . .
Please pay account number 5982 8309 sorting code 72-00-01 of the Somersetshire Coal Canal Society at the Alliance and Leicester Bank the sum of £7.50 / £5.00 / £37.50 on the ....... day of ...........................and each year thereafter until further notice from my / our account specified above.
Signed
[Delete where applicable. Insert your choice of payment day, month and year - being at least 30 days ahead of the day you dispatch this application.] TO BANK: When making payments please quote SCCS Membership Reference Number: .................................

When completed, please return this form to:
MEMBERSHIP SECRETARY - JOHN BISHOP
73, Holcombe Green, Upper Weston,BathBA1 4HY
E-mail: cesjtb[at]bath[dot]ac[dot]uk   

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