BLS Membership Application Form

    Personal Information

    Salutation: (required)

    Foreneme: (required)

    Surname: (required)

    Address including Postcode: (required)

    Email Address:

    Daytime Telephone:

    Evening Telephone:

    Moble Telephone:

    Interests & Activities

    Interests relevant to the aims and activities of B-LS:

    I can help B-LS by...

    Fundraising for Good Causes:


    By giving a talk about:

    By Writing a "Tiltas" article about:


    Subscription & Gift Aid

    Please select your subscription rate: (required)

    My extra Gift Aid donation to the Tiltas Trust is :

    GIFT AID DECLARATION: I am a UK taxpayer and eligible to Gift-aid my donation. This will increase my gift by 25p for every £1 given. I consent to the transfer of my personal data by B-LS to The Tiltas Trust for the purpose of reclaiming Gift Aid from HM Revenue and Customs.

    I Agree with the Gift Aid Declaration


    I consent to receive communications from B-LS: invitations to B-LS events, and events by other societies or institutions, other information about B-LS activities. I consent to receiving copies of Tiltas journal.
    (if nothing is specified, we will assume ‘yes’).


    Please enter the following code: