Subscription form for Gustaf Adolf Nordic Congregation

PLEASE PRINT OUT AND SEND WITH A CHECK TO 138 Park Lane, Liverpool L1 8HG

2017  Subscription form for membership of the 

Gustaf Adolf Nordic Congregation Company 

at Gustaf Adolf Church, Liverpool

 Company registration in England and Wales 7034654

As a member you have the right to vote at the congregation’s AGM and elect the church council members/directors. This board decides on the activities and expenditures of the parish.

It has been decided that we should recommend a congregational membership fee of £25 per annum for each individual and you must be over 18 years of age. We are aware that you might not be able to pay as much but we do appreciate whatever you can contribute to the congregation.

1st person in the household  —-Capitals, please: 

I ………………………………………………………………….. wish to make a donation of £………..for 12 months.

OR:  I wish to make  a standing order for  £…………/  month/year. Please contact Harriet Busby for this.      I wish to be a member……   or a sponsor…….. (tick appropriately)

Signature: ………………………………………………………………………………………….Date…………………..

Address…………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………

Phone…………………………….Email…………………………………………………………………………………………

IMPORTANT!    By giving us your email address you agree that we can contact you in this way.

2nd person in the household:  —-Capitals, please:

I  ……………………………………………………………………wish to make a donation of £…………..for 12 month.

OR: I wish to make a standing order for £…………/  month/year. Please contact Harriet Busby for this.

I wish to be a member……   or a sponsor…….. (tick appropriately)

 Signature: ……………………………………………………………………………………………..Date………………….

Address…………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………

Phone…………………………….Email…………………………………………………………………………………………

IMPORTANT!  By giving us your email address you agree that we will contact you in this way.

Make cheques payable to Gustaf Adolf Nordic Congregation.     Send this form to 138 Park Lane, Liverpool, L1 8HG.  I am/we are willing to volunteer and can help in these areas:

 _______________________________________________________________________________________________________

Charity Gift Aid Declaration – In order to Gift Aid your donation you must tick the circle below:

 Ο    I want to Gift Aid my donation of £________and any donations I make in the future or have made in the past 4 years, to Gustaf Adolf Nordic Congregation Company.  I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Title ______ First name or initial(s) ______________ Surname ________________________________________

Full Home address _________________________________________________________________________________

_________________________________________________________ Postcode ______________ Date_____________

Please notify the charity if you want to cancel this declaration; change your name or home address;  no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

 

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