BLS Membership Application Form

Salutation: (required)

Select Your TitleMrMrsMissMsDrProfRevOther

Foreneme: (required)

Surname: (required)

Address including Postcode: (required)

Email Address:

Daytime Telephone:

Evening Telephone:

Moble Telephone:

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

I can help B-LS by...

Fundraising for Good Causes:

YesNo

By giving a talk about:

By Writing a "Tiltas" article about:

Other:

Please select your subscription rate: (required)

Ordinary Member: £20.00Sustaining Member: £45.00 of which Gift Aid to the Trust: £20.00Corporate Member: £90.00 of which Gift Aid to the Trust: £60.00Students: £5.00LIFE MEMBER: £300.00 of which Gift Aid to the Trust: £100.00

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’).

Yes

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