Please complete all boxes in block capitals

PERSONAL DETAILS
Mr.    Mrs.    Miss    Ms    Dr.    Prof.    Other
First Name
Surname
Address
Town
County
Post Code
Home Telephone No.
email address

Gift Aid

I am a UK taxpayer, and I wish the BCG to treat as Gift Aid Donations all membership subscriptions and donations I have paid since 06/04/2000, and all membership subscriptions and donations I make from the date of this declaration.
(Remember to notify the BCG if you change your address or no longer pay income tax equal to the tax we reclaim on your donations.)
 
Signature______________________________ Date__________


MEMBERSHIP TYPE
1a       1b      1c       1d      2       3
New Member Renewal Membership Number
Membership Fee£
Yearly Appeal Donation£
Total (enclosed or to be debited on a yearly basis)£
 

Cheques / Postal Orders should be made payable to the British Chelonia Group and sent to:-

The Membership Secretary
British Chelonia Group
P.O. Box 1460
Bedworth
CV 12 9ZR

If you wish to pay your subscription by Direct Debit, this can be arranged by completing the following Direct Debit form.

PLEASE ENCLOSE a 9 x 6.5 inch Stamped Address Envelope for your Membership Information Booklet.


Instruction to your Bank or Building Society to pay by Direct Debit ddlogos
BANK/BUILDING SOCIETY ACCOUNT DETAILS
Originators Identification Number

9

4

8

3

2

2

Reference Number (for office use only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registered Address:
P.O.Box 1460, Bedworth. CV12 9ZR
 

To the Manager
Bank/Building Society
Branch (Full Postal Address)
Name of Account holder(s)
Branch Sort Code
   
Bank/Building Society Account No.
             

Instruction to your Bank or Building Society
Please pay the British Chelonia Group Direct Debits from the account detailed in the Instructions subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with the British Chelonia Group and if so details will be passed electronically to my Bank/ Building Socety.
 

Signature(s)______________________________ Date__________

SPECIES KEPT
(please complete)		 Adult
11 years & over		 Juveniles
5-11 years		 Hatchlings
0-5 years
  M F M F  
Hermann's Tortoise
(Testudo hermanni)
Spur-thighed Tortoise
(Testudo graeca)
Horsfield Tortoise
(Testudo horsfieldi)
Marginated Tortoise
(Testudo marginata)
Leopard Tortoise
(Geochelone pardalis)
Sulcata Tortoise
(Geochelone sulcata)
Others
(please state species)
Are you willing to accept unwanted Chelonia
Tortoises
Yes   No
Terrapins
Yes   No
Are you willing to accept sick Chelonia
Tortoises
Yes   No
Terrapins
Yes   No
If you have completed all the fields above, this form is ready to print. Don't forget to sign the form.
After Printing press the back button on your browser to return to the previous screen