Application for Membership (please print)        [print]   [close]

I wish to become a member of the Rural Theology Association.

Individual membership       £15.00 p.a.

Organisation membership

and library subscriptions     £30.00p.a.

Overseas membership        £25.00 p.a.

I also enclose a donation of £...................

Total amount                      £.................

Please make cheques payable to the Rural Theology Association and send them with this form (including the Banker's Order below) to:

The Revd Stephen Cope, RTA Secretary, The Vicarage, 28 Park Avenue, Withernsea, E Yorks HU19 2JU  01964-611462

Name (Block letters)............................................

Address........................

...................................

.............................

Email address..............................

Telephone .....................................

I am a tax-payer and wish the tax paid to be recovered under the Gift Aid scheme (delete if necessary)

Signed.....................

Date................

It would be a great help if you could pay by Banker's Order. An appropriate form follows. We also accept CAF or other Charity Vouchers.

Our Registered Charity Number is 327029

Banker's Order

To (name and address of own Bank)

Please pay to National Westminster Bank, Driffield Branch (sort code 60-07-05) for the account of the Rural Theology Association (account no. 01162691)

the sum of £................................. (in figures)

(.................................................................) (in words)

on......................................20......   (insert date)

and a like sum each following year until such time as this Banker's Order is varied or cancelled.

Signed.................

on the............................day of .....................................20..........

Account Number

Account Name