North of Ireland Family History Society

Amended July 2013

NORTH OF IRELAND FAMILY HISTORY SOCIETY CHARITY NUMBER XR 22524 Form A …………Coleraine… Branch - 2013 / 2014 SEASON

I ( WE ) APPLY FOR SINGLE ( JOINT ) ANNUAL BRANCH MEMBERSHIP (i.e. Joint = special rate for 2 people living in one household)

Membership entitles you to go to any Branch and the two journals “North Irish Roots” published in Autumn and in Spring

TITLE FORENAMES SURNAME

ONE MEMBER

JOINT MEMBER

ADDRESS ……………………………………………………..………… TELEPHONE - code …………..………..

..………………………………………………………,……………BT …… - number …………………...

Your email address (please print) ______

I agree to my details and interests being held on computer for use in Society publications

SIGNED : ______(one member) DATE : ______

SIGNED : ______(joint member) DATE : ______

GIFT AID From 1.4.2000 for each UK Tax payer, we may claim tax relief on Membership.

The Society will treat any membership and donation paid by you and any further payment made while you remain a member - as a Gift Aid donation - If you agree and this applies to you - please tick this box

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify.

Please notify the Society if you: want to cancel this declaration, change your name or home address or no longer pay sufficient tax on your income and/or capital gains.

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

What you are 2013 / 2014 SUBSCRIPTION sending Single membership £18.00 Joint membership £33.00 Single Membership (Affiliate) £19.00 Joint Membership (Affiliate) £35.00 To make a donation to Branch Funds, include here:- £ TOTAL AMOUNT ENCLOSED NB cheques payable to:-“North of Ireland Family History Society”

Please send this form and cheque immediately to the Branch Treasurer:- Mr T Barnett 44 Charnwood Park, Coleraine, BT52 1JZ, N. Ireland

For Office Bearers Use Only

NB please forward these original forms PLUS a “Form B Branch Capitation Form” with appropriate monies as soon as possible to Council Membership Secretary i.e. Ms R Sibbett, 216 Antrim Road, Newtownabbey, Co Antrim BT36 7QY who will return a numbered list to each Branch. Date Rec'd by Branch Date Rec'd by Council and recorded as current member Branch Member Number B ……………