| Title................... | Forename/s............................................................................................................. |
| Surname......................................................................................................................................................... |
| Title................... | Forename/s............................................................................................................. |
| Surname......................................................................................................................................................... |
| Address.......................................................................................................................................................... |
| ............................................................................................................... | Post Code......................... |
| Email Address............................................................................................................................................... |
| Tax payers: Please note that recent changes in the UK tax law now enables registered charities to reclaim 28p from the Inland Revenue for every £1 you donate. This costs you nothing, all we ask is that you sign the declaration below. |
| Donation £.............................. | Please tick box if you pay UK tax |
| Declaration |
| I request that The Poulton Project treat this as a donation for membership of The Friends of Poulton and all subsequent renewal payments, as Gift Aid Donations. |
| Signature of the person making the donation.............................................................................................. |
| Address if different from above.............................................................................................................. |
| Please make your cheques mayble to The Poulton Research Project and post to: |
| Friends of Poulton, c/o 17 Canadian Avenue, Hoole, Chester, CH2 3HG |
| Thank you |