Delius Society

Title and Name:*

Address and post code / zip code:*

Email address:*

Please receive my subscription for the year beginning 1st April

To assist our promotional focus, please state what prompted your application for membership (e.g. introduced by a friend, this website, or the website of another Society):

STANDING ORDER MANDATE

To:

Address and post code:

Sort code:

Please pay to Lloyds Bank, 22 Bridge Street, Stratford-upon-Avon, Warwickshire CV37
6AG, sort code 30-98-26, for the credit of The Delius Society Account No. 02628652, the
sum of £32.00 (thirty-two pounds only)

and thereafter annually on 1st April, until further notice and charge the following account:

Name:

Account No:

Signature:

Date

GIFT AID
If you are a UK taxpayer, please consider Gift Aiding your subscription. For your £32 Gift
Aid subscription, the Society receives £8 from the HMRC at no extra cost to you.
Well over half of our UK Members subscribe in this way. If you decide to do likewise,
please also complete the Gift Aid Declaration below.

GIFT AID DECLARATION

Title & Full Name (block capitals, please):

Address and post code:

email address:

I wish The Delius Society to treat all donations I have made since 1st April 2019 and all donations I make to The Delius Society in future, until I notify you otherwise, as Gift Aid donations.

Signature:

Please remember to notify us if at any stage you cease to pay UK income tax or capital gains tax.