Jane Austen Society UK : Midlands Branch Membership Application

Jane Austen Society Midlands

Application for Membership

PLEASE COMPLETE IN BLOCK CAPITALS

Full Name:

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(please state Mr/Mrs/Miss/Ms etc)

Address:

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Postcode:

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Telephone

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E-mail

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Please state if you are in paid employment: Yes/No

I apply for membership and enclose a cheque / standing order form for an amount of £12.00 (Full Rate) / £10.00 (Concessionary Rate), or for Life Membership with a one-off payment of £120.00 / £100.00.

Notes:
	1.	Concessionary rates of membership apply to those members who have no earned income. They may have pensions from occupational schemes, as well as personal pension plans, in addition to state pensions.
	2.	You may increase the value of any payment made by completing a Gift Aid donation form. If you pay tax, this increases the value to the Society from £12 (say) to £15 in this tax year, when the basic rate is 20%. If you pay tax at a higher rate, say 40%, then you may personally claim a tax refund using your self-assessment form. Typically this would be £2.40. You may go back for up to six previous tax years.
	3.	Please indicate below how you found out about the Society:
		I found out about the Jane Austen Society Midlands Branch through: The Main Society / A Friend / Local Library / Keele University Or through: