Membership Application

MEMBERSHIP APPLICATION FORM
(Single person: £12.50 Couple: £17.50)

NAME(S.......................................................................................................................................

ADDRESS....................................................................................................................................
POST CODE.......................................................Tel. No................................................................

Email address..............................................................................................................................
I would like my details to be included on the next membership list Yes / No

How did you hear about us?..............................................Approx. acreage.....................................
Livestock/crops/activities..............................................................................................................
...................................................................................................................................................
Any skills/experience etc which might be of use to others.................................................................
..................................................................................................................................................
I would be interested in attending any training courses on...............................................................
Thank you for taking the time to complete this form

PLEASE EITHER :
Enclose a cheque for £ ........... for your subscription to The Smallholders Association
OR
Fill out the standing order mandate below

GIFT AID IT : As long as you are a UK taxpayer, SHA can reclaim tax on your donations at no extra cost to you. Please indicate whether you wish SHA to claim Gift Aid on all donations you have made until further notice. Yes / No

Your signature: ................................................................. Date:...............................................

STANDING ORDER MANDATE for Smallholders Association
MEMBERS DETAILS (please write legibly and complete all sections of this form)

(Your) Account Name	.
Bank Address & Post Code	.
Account No	_ _ _ _ _ _ _ _
Sort Code	_ _ - _ _ - _ _
Please pay £.................. (amount in words ...................................................) on the 1st July each year from this date onwards and mark credit to the Smallholders Association with my account name, to be paid to :
Name	The Smallholders Association (Somerset)
Bank	CAFBANK, 25 Kings Hill Avenue, Kings Hill, West Mailing, Kent ME19 4JQ
Sort Code	40 - 52 - 40
Account	00018330
Your Signature.................................................................. Date........................................

Please return to the Membership Secretary :-Mrs Ann Parkhouse,
Fosse House Farm, Lydford on Fosse, Somerton, Somerset TA11 7DW