Please "Right Click" once anywhere on this page, then select the "Print" Option                                                   (3rd March 2001)

Membership Form

Part 1

Subscriptions are due on joining and thereafter annually on the same date. The annual subscriptions are :-

Single £10.00, Joint £18.00, Family £23.00, Life Membership £250

I hereby apply for _____________________ Membership

Names in full ________________________________________________

Address ____________________________________________________

___________________________________________________________

__________________________ Post Code ___________

Telephone Number _____________________ E-Mail Address ____________________

Particulars of Joint and Family members must also be shown on this form together with Dates of Birth of children under the age of 18.

Every penny counts in realising the Jetage Museum's project. If you would like to make a donation over and above the annual subscription, please indicate the amount below.

£5.00 [ ] £15 [ ] £25 [ ] Other £ _______

I enclose my cheque for £ __________ (made payable to GAC), (subscription, plus donation if any).

Part 2

BANKER'S ORDER

Paying by Banker's Order saves you the trouble of renewing your subscription each year. You can cancel it at any time.

Name in full ________________________________________________

Address ____________________________________________________

___________________________________________________________

__________________________ Post Code ___________

Telephone Number _____________________ E-Mail Address ____________________

Please pay Girobank plc (sort code 72-00-05), Bootle, GIR 0AA for the credit of Gloucester Aviation Collection (account number 3211 6704) £ ____________ (in words ____________________) on __________________ and thereafter annually until cancelled by me.

Account No. __ __ __ __ __ __ __ __

Bank Sort Code ____ - ____ - ____

Signature _____________________________________________________ Date _____________________________

To the Manager (your bank) ______________________________________________________

Address _____________________________________________________________________

_____________________________________________________ Post Code ______________

(please return completed Bankers Order to the Membership Secretary and not to your Bank)

Part 3

In order that GAC may reclaim from the Inland Revenue the amount of tax you have already paid on your subscription, please complete the following and return it to the Membership Secretary,  when paying your subscription :-

"I...........................................of.............................................................membership number................................

certify that I have paid tax at the standard rate on my subscription of £......This mandate is to remain in force until cancelled by me.

.............................................Signature.......................Date"

Please note that the above  certificate is in lieu of  Covenants,  which have just been withdrawn by the Inland Revenue.

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GENERAL NOTES

Life members paying by instalments should complete a Banker's Order for 4 payments of £50.00 (or £62.50) terminating in year 4 after payment.

Please complete parts 1, 2 & 3 as necessary and return to :-

Membership Secretary :-  K Lewer, 46 Kittiwake Drive, Kidderminster DY10 4RS  Tel 44 (0) 1562 743295 (Evenings Only)