MEMBERSHIP APPLICATION FORM

YES, I/we would like to become a member of the Friends of the Centre for Complementary Care.

I/We enclose cash or a cheque made payable to “The Centre for Complementary Care” OR I enclose a completed Banker's Order form in favour of the Centre.

in the sum of: £……………………………………….

(£20.00 per individual, £25.00 per couple or family and whatever-you-can-afford in cases of hardship (you don't have to plead your case - just send the money …!)).

Please complete the form below if you are a standard or higher rate tax payer and you haven't already completed one.

Please reclaim the tax on all my donations to The Centre for Complementary Care, Eskdale made since the 6th of April 2000, including the above Friends' Subscription, and on any donations I make from now on.

Signed: ………………..………….………………………….……..………………………….

Dated: ……………………………..…2004

(Please PRINT your FULL name in the section below – we need it to claim the tax back from the IR.)

Title: (Mr/Mrs/Ms/Dr) ……………….

Forename(s): ……………………………………………………………………………………………...

Last name: ……………………………………………………………………………………..…..……..

Address:………………….……………………………………………………..…………….………..…..

…………………………………………………………………………………………………………….........

Telephone number: ………………………………….……………………………..…………………..

Please return to: Moira Briggs, Manager, Centre for Complementary Care,
Muncaster Chase, Muncaster, Ravenglass, Cumbria, CA18 1RD.