Rotherham Family History Society
Registered Charity No 1113670

 
Membership Application/Renewal Form
Please Complete in BLOCK CAPITALS
Former membership number ................................ (if applicable)
 
Title (Mr / Mrs / Miss / Ms / Dr / etc)................................................................
 
Surname ...........................................................................................................
 
Forename(s) .....................................................................................................
 
Address..............................................................................................................
.............................................................................................................................
.............................................................................................................................
 
Post Code .........................................................................................................
 
Country ...............................................................................................................
 
Phone No. ..........................................................................................................
 
Email Address...................................................................................................
GA Lgog
GIFT AID DECLARATION

I am a UK taxpayer and I wish Rotherham FHS to treat as Gift Aid Donations all donations (inc membership subscriptions), I have paid since 6th April 2000 and all donations (inc membership subscriptions) that I make from the date of this declaration until I notify you otherwise. I understand that I must pay income tax or capital gains tax at least equal to the tax reclaimed by the Society.


Signed:..................................................... Date:................................................

I enclose the Annual Membership subscription of
Individual £11.00 : Family Membership £13.00 : Overseas £14.00:
Please make cheques payable to : Rotherham F. H. S


Signed ..................................................... Date.................................................

Please return completed form to :

Mrs Margaret Ensor
20 Rose Hill Avenue, Rawmarsh, Rotherham, South Yorkshire.  S62 5NA
(Please ensure that you use the correct address)