Leeds & District ME Group baner

Joining Form

Please email your details to the Membership Secretary or print this form out and return it.

To: The Membership Secretary, 15 West Parade, Guiseley, Leeds, West Yorkshire, LS20 9EU

Data Protection Act 1998

By completing and returning our form you give consent for the Leeds & District M.E. Group to process and store the personal data it contains solely for the purpose of administering your membership of the Group. The data will not be disclosed to any third party except where disclosure is required by law. The giving of this consent is a condition of membership.

Please tick boxes as appropriate:-
tick-box I would like to join the Leeds & District M.E. Group and receive a copy of the latest newsletter, with details and further information
tick-box Please send me further information and a sample newsletter.
 
Name:
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Address:





Postcode:
 
Email:
 
Telephone: 		. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
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tick-box I enclose a donation of £ . . . . . . . . . .
Please make all cheques/postal orders payable to
LEEDS & DISTRICT M.E. GROUP
tick-box I would like a receipt and have enclosed a stamped self-addressed envelope

Gift Aid Declaration
tick-box I would like the Leeds & District ME Group to reclaim the tax I have paid on this donation
Note: You must pay a sum of Income or Capital Gains Tax equal to the tax reclaimed on this donation and ALL other Gift Aid donations you make in the tax year (currently 28p for every £1 you give).
Date of Declaration: . . . . . . . . . . . . .

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .