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:

 Yes No

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 would like The Tiltas Trust to reclaim the tax on this and all
future donations until I notify you otherwise. I confirm I pay as much UK income or capital
gains tax as The Tiltas Trust will reclaim in the tax year
(currently 28p against every £1 donated).

 I Agree with the Gift Aid Declaration


Do you agree to your contact details (e-mail address or telephone number) being included in a list of Society members circulated to other members but not to anyone outside of the Society?
(if nothing is specified, we will assume ‘yes’).


Please enter the following code: