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To pay by cheque please print this page and fill in the details asked for below. When completed please 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. * |
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Benefactor £100 p.a. |
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| Joint Membership £40 p.a. |
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Junior Member £10 p.a. |
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| Life Member £500 |
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Life Benefactor £1,000 |
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| Corporate Member £500 p.a. |
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Optional Donation £.......... |
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(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 .........................................
Enclosed is my cheque for £........................ made out to the Galapagos Conservation Trust.
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