Online Membership Application Form Online Membership Application Form Membership Application Title * Forename * Surname * Address * Postcode * Email * Phone Number Please fill in your numbers with no gaps. Mobile Number The Society needs to have your permission before we can make contact with you.We prefer to contact you by email as this is the least expensive method. You can receive information about visits, events and lectures. The Society’s Privacy Policy is available to download here. Please inform the Membership Secretary if you wish to withdraw any of these permissions.Please indicate whether we may contact you in the future in all four of the options below: Email * Yes No Phone * Yes No Text * Yes No Post * Yes No Where did you hear about Abergavenny Local History Society? Local Press Website Word of Mouth Other If you answered "Other" above, please tell us more Gift Aid Declaration Please only fill in this section if you are a UK tax payer, otherwise please proceed to the "Submit Application" button. Declaration of Donor I would like the charity to treat all subscriptions or donations I have made on and since the date of this declaration, until I notify you otherwise, as Gift Aid donations. Gift Aid Confirmation - please type name in lieu of signature Date Gift Aid Notes:1. If your declaration covers donations/subscriptions you intend to make in the future, please notify the charity if youchange your address. You can cancel the declaration at any time by notifying Abergavenny Local History Society.2. You must pay an amount of income tax and/or capital gains tax at least equal to the tax that the society reclaims onyour donations in the tax year (currently 25p for each pound you give).3. If in the future your circumstances change and you no longer pay tax on your income and capital gains tax equal tothe tax that the charity reclaims, you can cancel your declaration (see Note 1).4. If you pay tax at a higher rate you can claim further tax relief in your self assessment tax return. Submit Application If you are human, leave this field blank.