BOURNEMOUTH NATURAL SCIENCE SOCIETY
(founded 1903)
39 Christchurch Road
Telephone 01202 553525
Bournemouth
Website: www.bnss.org.uk
Dorset, BH1 3NS
United Kingdom
Registered Charity Number 219585
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Membership Application Form (new members and renewals)
BLOCK CAPITALS PLEASE
Title …..……. Forename(s) ……….….……………………..………………..…….… Surname ……….………………………………………………..
Address……………………………………………………..…………………………………………………………………………………………………….………
……………………………………………………………………………………………………………………………...… Post Code ..………………….……..
Telephone Number ………………………………..…… E-mail address …………………………………….…………………….……
Additional adult details (if applying for joint membership)
Title ………… Forename(s) ……………………………..……........................... Surname ……………………….…..……………………….….
Date of birth (required if under age 26) ……/……/…….
Membership runs annually from the date of joining.
Please tick only one box to indicate the category of membership required.
Annual
Tick here
Subscription
if paying by
Discounted Annual Subscription
Membership category
(Cash, Cheque Cash or Cheque
(Quarterly Direct Debit)
etc.)
Single adult (26 years and over) £56 per annum
£52 per annum, payable as £13 per quarter
th
collected on 5 day of the month every 3 months
Joint/family (up to 2 adults
£85 per annum
£80 per annum, payable as £20 per quarter
th
plus children under 18)
collected on 5 day of the month every 3 months
Young person (17 years and
£10 per annum
under)
Student (age 18-25 or with
£20 per annum
valid student card)
Ten year single
£499
Tick here
if paying by
Direct Debit






Ten year joint
£699


I/we wish to apply for membership of the Society, agree to abide by the Rules, and would like to pay my/our
subscription (tick one):
 Cash or Cheque. My/our annual subscription of £........... accompanies this application.
 By Quarterly Direct Debit. I/we have completed the Direct Debit mandate on page 3.
Signature(s).................................................................................................................... Date........./........./............
/PTO for Donations and GiftAid
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SECTIONS: Archaeology & History, Astronomy, Botany, Entomology, General, Geography, Geology,
Ornithology, Science, Zoology
Page - 1 Version 3, July 2014
BOURNEMOUTH NATURAL SCIENCE SOCIETY
(founded 1903)
39 Christchurch Road
Telephone 01202 553525
Bournemouth
Website: www.bnss.org.uk
Dorset, BH1 3NS
United Kingdom
Registered Charity Number 219585
----------------------------------------------------------------------------------------------------------------------------- ---------------------------
I/we would also like to make an additional one-off or regular quarterly donation (please fill in details below):
Donation
One-Off single donation
Recurring Quarterly DD donation
Subscription (rate as above)
£
£
General Fund
£
£
Garden Fund
£
£
Phyllis Winter Memorial Lecture Fund
£
£
Lantern Roof Fund
£
£
Total: £
£
For joint members who wish to use GiftAid, the rules require a signature from everyone who is a taxpayer.
If more than one of you is a taxpayer, could appropriate individuals please sign and date the form below.
Use Gift Aid to make your donations, including membership subscriptions, worth
more. For every pound you give us, we earn an extra 25p from the Inland
Revenue. It’s that simple.
I would like Bournemouth Natural Science Society to reclaim tax on all my donations
and subscriptions made since 6th April 2000 and all donations and subscriptions
hereafter.
I understand that I must pay sufficient income tax or capital gains tax to at least
equal the amount that BNSS will reclaim on my donations and subscriptions in the
tax year.
Signed: .………………………………………………………………….
Date ………………………
Print name: ……………………………………………………………………………
Signed: .………………………………………………………………….
Date ………………………
Print name: ……………………………………………………………………………
Please remember to notify us if you become a non-taxpayer in the future.
/PTO for Direct Debit Mandate
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SECTIONS: Archaeology & History, Astronomy, Botany, Entomology, General, Geography, Geology,
Ornithology, Science, Zoology
Page - 2 Version 3, July 2014
Eazipay Ltd re Bournemouth
Natural Science Society
Please fill in the whole form using a ball point pen.
Eazipay Ltd re Bournemouth Natural Science Society
39 Christchurch Road
Bournemouth
BH1 3NS
Instruction to your Bank or Building
Society to pay by Direct Debit
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Society.
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Reference
Date
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The Direct Debit Guarantee
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