APPLICATION FORM
Please complete in BLOCK CAPITALS and return to:
The Chairman, Huddersfield Canal Society Limited,
The Transhipment Warehouse, Wool Road, Dobcross, Saddleworth, Oldham, OL3 5QR.
I/We* wish to apply for Ordinary/Family/Associate/Life* membership of the Huddersfield Canal Society Limited and I/We* hereby agree, if elected, to be bound by all the provisions of the Memorandum and Articles of Association of the Society. (Copies can be inspected at the Ashton office during normal working hours). 
I am over 16. *delete as applicable

Rates:  Individual - £9   Family - £11   Life - £90   Associate (Voluntary groups) - £15
Title (Mr, Mrs, Dr, etc)

Names in full
Address
 

Post Code

Telephone

EMail

Occupation

Signed

 Date

Subscription

 £  

Donation

 £ Thank you

Total amount enclosed

 £  

Make cheques payable to 'Huddersfield Canal Society Ltd' or please consider using a Standing Order

STANDING ORDER (Please complete in CAPITALS)
To: (Name of your bank)  
at: (Bank's full address)  
 
Please pay to the Cooperative Bank plc, Leeds Branch, Vicar Lane, Leeds, LS1 1HJ, (Sort Code 08-90-72) for the credit of Huddersfield Canal Society Ltd, account no. 70080681,
on the (Date) the sum of £          and the same amount annually until further notice.

(Members must inform their banks if they wish to cancel their subscription)
Debit my   (type of account)

Account No.

   accordingly
Signed   Name (in CAPS)  
 
Address  
 

Post Code

 

Date

  
If you are a taxpayer, you can increase the value of your subscription by completing this declaration:

GIFT AID DECLARATION

Name of Charity: HUDDERSFIELD CANAL SOCIETY - Reg. No. 510201
Details of Donor:

Name

  

Address

  
 
I wish the Charity to treat all subscriptions/donations I make on and after the date of this declaration until I notify you otherwise as Gift Aid donations.
Signed  

Date