1st Member Title

1st Member Name

First Name

Last Name

1st Member email

Phone number

1st Member phone number

2nd Member Title

2nd Member Name

First Name

Last Name

Phone number

2nd Member phone number

2nd Member email

Address

House Number / House Name

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gift Aid

The Parkgate Society can benefit from the Gift Aid Scheme if you pay UK income or capital gains tax. We can reclaim the tax on your membership subscription or donation: for every £1 you give, we can claim an extra 25p from the Inland Revenue.

Do you consent to Gift Aid your subscriptions and donations now and in the future?

Who is the Gift Aid donor? Please select.

Date