To pay by Banker's Order please print this page and fill in the details asked for below. When completed, please remember to sign and date, and send to:
The Galapagos Conservation Trust 5 Derby Street London W1J 7AB United Kingdom
Please contact the GCT office if you have any questions, at the above address or by phoning +44 (0)20 7629 5049 or emailing gct@gct.org.
Member £30 p.a. *
Benefactor £100 p.a.
Joint Membership £40 p.a.
Junior Member £10 p.a.
Life Member £500
Life Benefactor £1,000
Corporate Member £500 p.a.
Optional Donation £..........
* Please add £5.00 for non-UK addresses
(Please check appropriate boxes).
If you are also a tax payer and wish the Galapagos Conservation Trust to reclaim tax by way of Gift Aid please indicate this at the bottom of this form.
Title .................................... Firstname ....................................................
Surname ...................................................................................................
Address ....................................................................................................
Town ........................................................................................................
Postal/Zipcode .........................................
Country ..................................................................
Email .......................................................................................................
If Junior membership, please include age of child .........................................
INSTRUCTION TO YOUR BANK TO PAY BY BANKER'S ORDER
Bank Name ............................................................................................
Bank Address .................................................................................................
Bank Sort Code ....................................................
Your Account Number .....................................................................................
Your Account Name ........................................................................................
Please pay the sum of £.................... now and on the same day each year until further written notice for the credit of the Galapagos Conservation Trust, Account No 0307840, Lloyds TSB Bank plc (30-99-10), 157-159 Wandsworth High Street, London SW18 4JA.
Signature ............................................................. Date ...........................
Yes!
I am a UK taxpayer - please reclaim tax on all my subscriptions and donations made since 6 April 2000.
