APPLICATION TO BE A FRIEND OF MARDEN HOUSE CONCERTS

Please print and complete this form, including the Gift Aid Declaration, and return with your cheque, payable to Marden House Centre, to the address at the bottom of the page.

I would like to become a Friend of Marden House Concerts and enclose a donation of
................ (min 10).

Name: ..........................................................................................................

Address: ......................................................................................................

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Telephone: ..................................................................................................

Email: ..........................................................................................................

If you are a UK taxpayer would you be prepared to sign the Gift Aid declaration?

Gift Aid Declaration: Friends of Marden House Concerts No:............
Marden House Centre (Reg. Charity No: 293514)

My full name: Title:............... Initial(s): ......................

Surname: .........................................................................

Address: ...............................................................................................................

.................................................................................................................................

.................................................................................................................................

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Postcode: ............................................................

I would like Marden House Centre (on behalf of Friends of Marden House Concerts) to treat all donations I have made since 6 April 2004, and all donations I make from the date of this declaration until further notice, as Gift Aid Donations. I know that I must pay an amount of income (or capital gains) tax at least equal to the tax the charity reclaims on my donations in the tax year.

Sum donated: ..............................

Signature............................................................. Date: ...............................................

Please return this form with your cheque to:

Lyn Cooper
31 Horsebrook Park
CALNE
Wiltshire
SN11 8EY
Tel: 01249 812025

Thank you.