Membership/donation form

Please print and complete using BLOCK CAPITALS
Name (Mr/Mrs/Miss/Ms/Other title)  ____________________________________________
Address  ______________________________________________________________________
_____________________________________________    Postcode  ____________________

ANNUAL MEMBERSHIP - please TICK which is required                        £
Individual £25.00                Couple/Family £35.00
Donation                                                                _______
TOTAL - please make cheques payable to "Shared Earth Trust"             _______

BANKER'S ORDER - the easy way to pay your membership and reduce administration
To  _____________________________________________  (insert name of your bank)
of  _____________________________________________
    _____________________________________________  (insert your bank's address)
Re my account number  ____________________      Sort Code  ____________________
Please pay to HSBC Bank, 8 High Street, Melbourne, Derby DE7 1GN for the 
account of the SHARED EARTH TRUST (account no. 21050745; sort code 40-32-12)
the sum of _________________________ pounds (£ ________ ) on the 
_____________________  (insert date of first payment) and make similar payments 
each ________________  (insert year, quarter or month as applicable) 
until cancelled by me in writing.

Signed  _________________________________________     Date ____________________
Your Name and Address  ________________________________________________________
_______________________________________________________________________________
______________________________________________     Postcode  __________________

If you are a UK taxpayer, you can increase your contribution through Gift Aid, 
enabling us to claim back the income tax you have already paid.

GIFT AID DECLARATION
I would like Shared Earth Trust to reclaim tax I have already paid on this and 
any future membership subscriptions and donations until I notify you otherwise.*

Signed  _________________________________________     Date ____________________
Name (CAPITALS)  ______________________________________________________________
Address (CAPITALS) ____________________________________________________________
_______________________________________________________________________________
______________________________________________     Postcode  __________________

* You must pay at least as much income tax, or capital gains tax, as we reclaim, 
i.e. 28p for every £1 you give. If you do not pay tax, you cannot complete the 
declaration. If you cease to be a taxpayer for any reason, please let us know 
immediately.