Membership Form

Forname:

Surname:

Address:

Town:

Post Code:

Are you happy for us to contact you by email?

(We will not pass your details onto anyone else)

Full Season Membership @ £36 for all shows:

Concessions* @ £24 for all shows:

Total to pay:   £

* Passport to Leisure / Full-time students / Receiving State Pension

I am / We are 16 years of age or over

Signature(s):.............................................................

Date:....................................

Please print this page and send it with your payment to:

Membership Secretary, Halifax Film Society, 13 Grandsmere Place, Halifax HX3 0DP

Cheques should be made payable to “Halifax Film Society”

www.halifaxfilm.org.uk

Telephone:

Email:

If you are a UK tax payer please complete this gift aid declaration form as this will enable us to claim extra money for every pound paid.

GIFT AID DECLARATION

I want the Halifax Film Society to treat all payment I have made since 6 April 2006 and all donations I make from the date of this declaration until I notify you otherwise as Gift Aid Donations.

Notes:

1. Please notify the charity if you change your name and address while the declaration is still in force.
    
2. You can cancel the declaration at any time by notifying the charity - it will then not apply to donations made on or after the date of cancellation or such date as you specify.
    
3. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the charity reclaims on you donation in the tax year.
    
4. If you pay tax at the higher rate you can claim further tax relief on your Self Assessment tax return.
    
5. If you are unsure whether your donations qualify for Gift Aid tax relief, ask the charity. Or you can ask your local tax office for leaflet IR 113 Gift Aid.