Sheffield & Rotherham Wildlife Recruiter: Trust, 37 Stafford Road, Sheffield, S2 2SF Tel: 0114 2634335. Location Registered Charity No 700638

I would like to pay: £ per month/year (delete as appropriate)

Type of membership: Individual Joint Family Family & Child(ren)

Title: Forename: Surname: DOB:

Title: Forename: Surname: DOB:

Address:

Post code:

Phone: Email:

I am happy to be contacted by my local Wildlife Trust about conservation, membership, fundraising and other activities by: Post email e-newsletters telephone text/SMS You can change your contact preferences at any time by contacting The Wildlife Trusts using the address or telephone number above.

Name of child (first name, surname) Date of birth M/F

Charity Gift Aid Declaration – Boost your donation by 25p of Gift Aid for every £1 you donate Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

I am a UK tax payer and understand that if I pay less Income Tax and/or Capital Gains in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. I agree to notify the charity if I no longer pay sufficient tax, want to cancel this declaration or if I change my name and/or address. Yes, I’d like to Gift Aid my donation and any donations I make in the future to Sheffield & Rotherham Wildlife Trust. Signature:______Name:______Date:______House Number/Name:______Postcode:______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. Instruction to your bank or building society to pay by Direct Debit

Please fill in the whole form using a ball point pen and send it to: Membership Officer, Sheffield & Rotherham Wildlife Trust, 37 Stafford Rd, Sheffield, S2 2SF Name(s) of account holder(s) Service user number 9 7 4 2 3 9 Reference

Bank/building society account number Reference

Bank/building society account number

Instruction to your bank or building society Please pay the Wildlife Branch sort code Trust Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with the Wildlife Trust and, if so, Name and full postal address of our bank or building society details will be passed electronically to my bank/building society. To: The Manager Bank/building society Signature(s)

Address Date:

Postcode Banks and building societies may not accept Direct Debit Instructions for some types of account

The Direct Debit Guarantee

 This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits  If there are any changes to the amount, date or frequency of your Direct Debit the Wildlife Trust will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request the Wildlife Trust to collect a payment, confirmation of the amount and date will be given to you at the time of the request.  If an error is made in the payment of your Direct Debit, by the Wildlife Trust or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society - If you receive a refund you are not entitled to, you must pay it back when the Wildlife Trust asks you to.  You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

I would like to join a different Wildlife Trust (please tick):

Avon Wildlife Trust, The Old Police Station, 32 Jacobs Wells Road, Bristol BS8 1DR 01179 177270 The Wildlife Trust for Beds, Cambs & Northants, The Manor House, Broad Street, Great Cambourne CB23 6DH 01954 713500 Berks, Bucks & Oxfordshire Wildlife Trust, The Lodge, 1 Armstrong Road, Littlemore, Oxford OX4 4XT 01865 775476 The Wildlife Trust for Birmingham & Black Country, 16 Greenfield Crescent, Edgbaston, Birmingham B15 3AU 0121 454 1199 Cheshire Wildlife Trust, Bickley Hall Farm, Bickley, Malpas SY14 8EF. 01948 820728 Cornwall Wildlife Trust, Five Acres, Allet, Truro TR4 9DJ 01872 273939 Cumbria Wildlife Trust, Plumgarths, Crook Road, Kendal LA8 8LX 01539 816300 Derbyshire Wildlife Trust, Sandy Hill, Main Street, Middleton, Matlock, Derbyshire, DE4 4LR, 01773 881188 Devon Wildlife Trust, Cricklepit Mill, Commercial Road, Exeter EX2 4AB 01392 279244 Dorset Wildlife Trust, Brooklands Farm, Forston, Dorchester DT2 7AA 01305 264620 Durham Wildlife Trust, Rainton Meadows, Chilton Moor, Houghton-le-Spring DH4 6PU 01915 843112 Essex Wildlife Trust, The Joan Elliot Visitor Centre, Abbots Hall Farm, Great Wigborough, Colchester CO5 7RZ 01621 862960 Glos Wildlife Trust, Conservation Centre, Robinswood Hill Country Park, Reservoir Road, Gloucester GL4 6SX 01452 383333 Gwent Wildlife Trust, Seddon House, Dingestow NP25 4DY 01600 740600 Hampshire & Isle of Wight Wildlife Trust, Beechcroft House, Vicarage Lane, Curdridge SO32 2DP. 01489 774400 Herefordshire Wildlife Trust, Lower House Farm, Ledbury Road, Tupsley, Hereford, HR1 1UT 01432 356872 Hertfordshire & Middlesex Wildlife Trust, Grebe House, St Michael’s Street, St Albans AL3 4SN 01727 858901 Kent Wildlife Trust, Tyland Barn, Sandling, Maidstone ME14 3BD 01622 662012 The Wildlife Trust for Lancs, Mancs & North Merseyside, The Barn, Berkeley Drive, Bamber Bridge, Preston PR5 6BY 01772 324129 Leicestershire & Rutland Wildlife Trust, The Old Mill, 9 Soar Lane, Leicester LE3 5DE 0116 262 9968 Lincolnshire Wildlife Trust, Banovallum House, Manor House Street, Horncastle LN9 5HF 01507 526667 London Wildlife Trust, Dean Bradley House, 52 Horseferry Road, London, SW1P 2AF 020 72610447 Manx Wildlife Trust, 7-8 Market Place, Isle Of Man, IM5 1AB 01624 844432 PLEASE NOTE: DOES NOT ACCEPT GIFT AID Montgomeryshire Wildlife Trust 42 Broad Street, Welshpool, SY21 7RR. 01938 555654 Norfolk Wildlife Trust, Bewick House, 22 Thorpe Road, Norwich NR1 1RY 01603 625540 Northumberland Wildlife Trust, The Garden House, St Nicholas Park, Jubilee Rd, Newcastle Upon Tyne NE3 3XT 01912 846884 North Wales Wildlife Trust, 376 High Street, Bangor LL57 1YE 01248 351541 Nottinghamshire Wildlife Trust, The Old Ragged School, Brook Street, Nottingham, NG1 1EA 01159 588242 Radnorshire Wildlife Trust, Warwick House, High Street, Llandrindod Wells LD1 6AG 01597 823298 Scottish Wildlife Trust, Harbourside House, 110 Commercial Street, Edinburgh EH6 6NF 0131 312 7765 Sheffield Wildlife Trust, 37 Stafford Road, Sheffield, S2 2SF 01142 634335 Shropshire Wildlife Trust, 193 Abbey Foregate, Shrewsbury SY2 6AH 01743 284280 Somerset Wildlife Trust, 34 Wellington Road, Taunton, Somerset, TA1 5AW Staffordshire Wildlife Trust, The Wolseley Centre, Wolseley Bridge, Stafford, ST17 0WT 01889 880100 The Wildlife Trust of South & West Wales, The Nature Centre, Fountain Road, Tondu, Bridgend, CF32 0EH 01656 724100 Suffolk Wildlife Trust, Brooke House, The Green, Ashbocking, Nr Ipswich IP6 9JY 01473 890089 Surrey Wildlife Trust, School Lane, Pirbright, Woking GU24 0JN 01483 795445 Sussex Wildlife Trust, Woods Mill, Shoreham Road, Henfield, BN5 9SD 01273 492630 Tees Valley Wildlife Trust, Margrove Heritage Centre, Margrove Park, Boosbeck, Saltburn-by-the-Sea TS12 3BZ 01287 636382 Ulster Wildlife Trust, 3 New Line, Crossgar, Co. Down, BT30 9EP 02844 830282 Warwickshire Wildlife Trust, Brandon Marsh Nature Centre, Brandon Lane, Coventry, CV3 3GW 02476 302912 Wiltshire Wildlife Trust, Elm Tree Court, Long Street, Devizes SN10 1NJ 01380 725670 Worcestershire Wildlife Trust, Lower Smite Farm, Smite Hill, Hindlip, Worcester, WR3 8SZ 01905 754919 Yorkshire Wildlife Trust, 1 St George’s Place, Tadcaster Road, York YO24 1GN 01904 659570

Thank you for joining The Wildlife Trust and giving £ a MONTH/YEAR. This section does not form part of your Direct Debit guarantee.  The Wildlife Trusts work to protect species and habitats on land and in our seas. We rely on membership subscriptions to fund our work.  The person who has signed you as a member today is an employee of The Wildlife Trusts who is being paid to undertake this work.  The Wildlife Trusts will never sell your contact details to another organisation and never share your data with other charities for marketing purposes.  Your personal details will only be used by the Wildlife Trust, and contracted organisations working on their behalf, to service your membership.  You will be registered as a member of your chosen Wildlife Trust and will receive your membership pack within 28 days. If you have any questions in the meantime, please contact us at Sheffield & Rotherham Wildlife Trust, 37 Stafford Road, Sheffield, S2 2SF. Tel: 0114 2634335. Website: www.wildsheffield.com . Registered charity no. 700638. Thank you for your support!