|
|
|
|
I wish to become a member
of the Optimum Population Trust.
My personal details are provided for use by OPT, on the understanding that
the data will not be divulged to other organisations
- commercial or otherwise - without my permission.
|
|
Title:
|
First
Name (& middle initial):
|
|
Last
name:
|
|
Address
1:
|
|
Address
2:
|
|
City/Town:
|
|
County/State/Province:
|
|
Post
code:
|
Country
(if not UK):
|
|
Telephone:
|
Fax:
|
|
E-mail:
|
|
COMMENTS:
|
|
Cheque enclosed: (select)
YES / NO
|
Subscription amount:
(select)
£15 £20
£_____.00
|
|
GIFT AID
I am a UK
taxpayer and want OPT to treat all my donations from this date
Date..............Mth..............Yr..........
as Gift Aid donations until further notice. (NB: you will need to pay an
amount of income tax and/or capital gains tax at least equal to the tax we
claim on your donations.)
YES / NO
|
|
STANDING ORDER MANDATE
(Please send to the OPT Membership Secretary in Manchester)
NAME OF BANK................................................. NAME OF
BRANCH.....................................................
POSTAL ADDRESS...........................................................................
..............................................................
............................................................
..................................................................
............................................
SORT CODE (IF KNOWN).................................... YOUR
ACCOUNT NUMBER......................................
INSTRUCTIONS TO YOUR BANK
Please pay to the Optimum Population Trust (account number 70905666 at
Barclays Bank, Urmston, sort code 20-01-96) the sum
of:
£.........................annually, starting on the ........... (day) of ......................... (month)...................(year)
(or as soon as possible after this date) until you receive further notice
from me/us in writing.
YOUR SIGNATURE................................................................
DATE...........................................................
|
|
Signature:
|
Date:
|