I (We) wish to apply for membership of the above Society

Surname(1):  .......................................................(Please state Mr., Mrs., Ms. or Miss)    Date: ..............

Fore Names.........................................................................Signature(1)  ................................................

Surname(2):  .......................................................(Please state Mr., Mrs., Ms. or Miss)     Date: .............

Fore Names........................................................................Signature(2) ..................................................

Address: ....................................................................................................................................................

............................................................................Post Code ..................... Telephone No ...........................

I agree / do not agree to my name and address being published in the Transactions. 

This form duly completed and accompanied by a remittance for the amount shown below or accompanied by the attached Banker's Order should be forwarded to the Hon. Membership Secretary,  Mr. Siôn Caffell, 1 Fronheulog, Sling, Tregarth, Bangor, Gwynedd LL57 4RD, (  01248 600 083.

Subscriptions: Individual members  £6.00; Joint Membership,  living at the same address,  £9.00 (One copy of Transactions); Membership to Institutions   £10.00

It would be appreciated if new members would 
1) complete a Gift Aid declaration and
2) pay by Banker's Order if possible.

I want all subscriptions/donations made to the Anglesey Antiquarian Society and Field Club since 6th April 2002, and all subscriptions/donations I make to the Society in future, to be treated as GIFT AID subscriptions/donations.
I confirm that I am a taxpayer, and pay an amount of Income Tax or Capital Gains Tax at least equal to the tax which the Society reclaims on my subscriptions/donation (i.e. 28p for each £1 of my subscription/donation

Signature ……………………………………………………… Date …………………………….

Anglesey Antiquarian Society and Field Club
Order to Member's Bankers to pay the Annual Subscription

To  ........................................................  Bank Plc (Sort Code ...........................)

Bank Address ..............................................................  Post Code .......................

Please pay now, and on the 1st April, in each year, until further notice to Lloyds Bank Plc,  Bangor (30-90-43) to the account of the Anglesey Antiquarian Society and Field Club (Account No. 1530845) the sum of £............. quoting my/our full name(s) and membership number on each payment and debiting my / our account No .................................... with you.

Full Name(s) ...........................................................................................Membership No: M.......................
(Please state Mr., Mrs., Ms. or Miss)
Address: ........................................................................................................................................................

.................................................................................Post Code ..................... Telephone no:.......................


Signature(s): .............................................................................................................. Date: .....................