Pembrokeshire U3A – Gift Aid Declaration (Renewal)

Member Details

Title

Forename 1

Surname 1

Phone1

Forename 2

Surname 2

Phone2

Select Amount Paid

—Please choose an option—£10£15£20£25

Address

House Name/No

Street

Village

Town

County

Post Code

Gift Aid Declaration

I wish to Gift Aid my membership payment

Signatures

Person 1 Full Name or Signature

Person 2 Full Name or Signature

Date