Membership Application Form

Become a member now and benefit from free entry to the garden, a copy of our annual magazine Ex Fonte
and information about special events for members only.

Please print out this form and send it together with payment, or standing order mandate   to ...

Penny Miller

Membership Secretary PGPT

The White House, 5 Earlham Road, NORWICH. NR2 3RA

I / We wish to become a member / members   of the Plantation Garden Preservation Trust

Name (s)

Address

Postcode

Telephone

Email

(will be used to inform you about PGPT special events and information. Your email address will not be passed to third parties )

Either I enclose a cheque made payable to PGPT    £7.50 (single - annual)*, £12 (family - annual)*  or for Life Membership, £150 single / £200 family
*Please delete as necessary.
We are able to accept CAF cheques.   Please Note: Family membership is limited to spouses, partners and children only please.   Family membership does not include grandparents, grandchildren, brothers, sisters, aunts, uncles, cousins, sisters- or brothers-in-law, boyfriends or girlfriends.           *However, please note that all accompanied children under the age of 16 have free admission to the Plantation Garden.

Or Complete the standing order mandate             Please tick here [       ]   if you are an existing member changing to Standing Order

GIFT AID DECLARATION

.I,    ............................................................................................... [please insert your full name] of address as shown above, would like The Plantation Garden Preservation Trust to treat this fee of £7.50 / £12.00 / £150 / £200 * 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 you are a UK taxpayer and you are kind enough to sign this part of the form, the PGPT can reclaim 25p for every £1 you pay us

STANDING ORDER MANDATE

* Essential information, please complete
Your Bank *		Sort Code *
Branch address *
Account Name *		Signature(s) *
Account Number *		Date *
Beneficiary (Payee) Details
Beneficiary Name: The Plantation Garden Preservation Trust		Bank Name: Bank of Scotland, Norwich
Sort Code: 12-09-25		Account Number: 00622909
Payment Details
Amount of Payment	* £	£7.50 or £12.00
Date of First Payment:	Immediately
Frequency of payment:	Annually, on date of first payment. Continue payment until further notice in writing
This order cancels any previous order made by me/us in respect of The Plantation Garden Preservation Trust

	Become a member now and benefit from free entry to the garden, a copy of our annual magazine Ex Fonte and information about special events for members only. Please print out this form and send it together with payment, or standing order mandate to ... Penny Miller Membership Secretary PGPT The White House, 5 Earlham Road, NORWICH. NR2 3RA
I / We wish to become a member / members of the Plantation Garden Preservation Trust
Name (s)
Address

Postcode
Telephone
Email
	(will be used to inform you about PGPT special events and information. Your email address will not be passed to third parties )

GIFT AID DECLARATION
.I, ............................................................................................... [please insert your full name] of address as shown above, would like The Plantation Garden Preservation Trust to treat this fee of £7.50 / £12.00 / £150 / £200 * 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 you are a UK taxpayer and you are kind enough to sign this part of the form, the PGPT can reclaim 25p for every £1 you pay us