Joint or Family Membership Application Form Application for Joint or Family Membership Name* DrMissMrMrsMsProf.Rev. Prefix First Last Joint Member Name* DrMissMrMrsMsProf.Rev. Prefix First Last Family Member Name DrMissMrMrsMsProf.Rev. Prefix First Last Family Member Name DrMissMrMrsMsProf.Rev. Prefix First Last Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country The same address will be used for correspondence to all family members.Home PhoneMobile PhoneEmail Alternative Email Gift Aid DeclarationBy ticking the box you can help us increase your subscription and gifts or donations by 25% at no cost to you. I wish membership subscriptions and donations that I pay to Gloucester Civic Trust Ltd to be treated as made under Gift Aid. I confirm that I have paid an amount of UK Income or Capital Gains Tax equal to any tax reclaimed. I understand that I can cancel the Gift Aid declaration at any time. Gift Aid Confirmation VolunteeringIf you would like information about how you could help with any of the following, please tick the appropriate box. Tour Guiding St Michael's Tower (a Heritage Centre) Stewarding during Heritage Open Days Administration Event Organisation Publicity & Marketing Social Media Technology The Folk of Gloucester (An event and exhibition space) How did you hear about Gloucester Civic Trust?Tick all that apply Our Website Visit Gloucester website Radio Gloucestershire At St Michael's Tower At The Folk of Gloucester Joining a guided walk of Gloucester Friend or family member Social media Other Consent Form*Please complete this form to authorise us to contact you. This should be read in conjunction with the Trust’s privacy policy which can be found on the Gloucester Civic Trust website (https://www.gloucestercivictrust.org/privacy-policy-2/) Select All I have read the Gloucester Civic Trust’s Privacy Policy and agree to my personal data being used as described I consent to receive information about Gloucester Civic Trust’s activities and events, as well as information about events organised by others that Gloucester Civic Trust considers may be of interest to you You may contact me by email (News Updates) You may contact me by post (Newsletters, Annual Report and notice of AGM)) You may contact me by telephone or text message Photographs*Gloucester Civic Trust may take photographs at events and these photographs may be used in future publicity materials. Given that Trust volunteers and staff may not be able to recognise everyone at an event, we would ask attendees to inform us if they do not wish their photos to be used in this way at the time the photographs are being taken. I have read and understood the Trust's policy on photography Consent* I understand the consents I have detailed above can be changed at any time by notifying the Trust via email (data@gloucestercivictrust.org )or by post. Initial payment*Subscriptions are payable on joining and then annually on 1st January. To make the initial payment online and set up a subsequent Standing Order, please use these bank details and as a reference use the surname and initial of the applicant. Bank name: Royal Bank of Scotland Sort Code: 16-20-20 Account Name: Gloucester Civic Trust Ltd. Account Number: 11573888 I confirm that I have paid the first subscription of £22 online. Untitled First Choice Second Choice Third Choice
