Print Membership Application Form

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...................................................................................................

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 £12.00 : Family Membership £14.00 : Overseas £15.00:

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)