Membership Agreement and Guarantee

I/we agree to become a member of Bristol Mind. Should the company be wound up, I/we promise to pay the sum of £1 towards its debts if asked to do so. I/we confirm that I am / we are in sympathy with the company's aims and objects.

About you or your organisation

Name of Individual / Organisation: *

Contact name for organisation:

Address: *

Postcode: *

Fax:

Telephone:

Email address:

Annual subscription

Rate: *

Individual £10

Individuals who define themselves either as being of limited means or being a 'User' of mental health services £3

Organisations £20

Donation: £ included in cheque

Donation by standing order: £ included in standing order

Payment method: *

Cheque payable to 'Bristol Mind'

I have set up a standing order

Gift Aid Declaration

If you are a UK tax payer and would like to make your donations (including your membership fee) worth almost a third extra please tick the box below. I am a UK taxpayer and would like Mind to treat all donations I have made since 6 April 2000 and all donations I make thereafter, as Gift Aid donations. I understand that I must have paid an amount of income tax or capital gains tax equal to the tax you reclaim on my donations.

Gift Aid Declaration:

Yes treat my donation as Gift Aid

Any message?:

What is two add 4?: *

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Membership Agreement and Guarantee

Bristol Mental Health Resources