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:

Other:

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

Privacy

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’).

 Yes
 No

Please enter the following code:
captcha