Please print out this form and send it together with payment, or payment details to ...

Jane Eggleston, Membership Secretary PGPT,

Garden House, Chester Place, NORWICH.  NR2 3DG

I/We wish to become a member(s) of the Plantation Garden Preservation Trust
Name  
Address  
   
Postcode  
Telephone  
Email  
Please enclose your cheque made payable to PGPT for  £7.50 (single)* or  £12 (family)*            *Please delete as necessary
or complete the standing order mandate below      Please tick if existing member changing to Standing Order  [    ] 
Please pay the Plantation Garden Preservation Trust [Bank of Scotland, Norwich: sort code 12-09-25 account number 00622909] the amount of £7.50 / £12.00* and thereafter on 1st January annually until further notice in writing and debit my/our account accordingly.

This order cancels any previous order made by me/us in respect of The Plantation Garden Preservation Trust
Bank   Sort Code  
Branch address  
Name   Signature  
Account Number   Date  

Gift Aid Declaration
 

I,                                                                      [please insert your full name] of address as shown above, should like The Plantation Garden Preservation Trust to treat this fee of £7.50 / £12.00* and all other donations and membership subscriptions I make from the date of this declaration as Gift Aid donation until I notify you otherwise. 

Signed   Date  

[If you are kind enough to sign this form and you are a UK taxpayer, the PGPT can reclaim 28p for every £1 you pay us]