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BNTVA Membership Application Welcome to the BNTVA, the charity for the Nuclear Community

All you have to do now: • Complete the Personal Details Section • If you are a UK Tax Payer please sign & date the Gift Aid form • Select Membership Type and Complete Payment Details • Return completed form to Freepost BH ASSOCIATES BH Associates manage the BNTVA Membership records on behalf of the charity

Personal Details

Name Address

Post Code Phone email Magazine Format

[ ] Postal [ ] On-Line [ ] Both If you are able to read the magazine on line you can save the BNTVA at least £12 a year

Data Statement The full BNTVA Data Protection Statement is available on our website. This form details all the information we hold about you. This information is only retained to identify your membership status and for us to communicate with you. As soon as your membership ceases this information is deleted.

Gift Aid Authorisation Boost your donation by 25p of Gift Aid for every £1 you donate Gift Aid is reclaimed by the BNTVA from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

In order to Gift Aid your donation you must sign below and tick this box [ ] I am the person detailed in this form and 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 The BNTVA Regd Charity 1131134. 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. Signed A Digital record of this page will be made for administration and gift aid purposes. The original form will be securely destroyed


Paying For Your Membership (Tick the Membership Type You Require)

(It’s due every year on the 1st of April)

[ ] Individual UK: [ ] UK Family:

£20.00 £30.00*

*Print the Name and Address of the other family member on the back of this form

Family membership allows additional dependent members of your household who are over the age of 16 the ability to vote in BNTVA meetings and ballots. They also receive their own membership card & copy of the magazine.

Ways to pay your BNTVA Membership: 1.[ ] Cheque Payment: Make cheque payable to BNTVA and return with this form. 2.[ ] On-Line Payment: Enter goo.gl/wipfVe into your browser. This takes you to our GoCardless secure payment system where you can set up a Direct Debit payment. All you do is tick the Membership Type and the On-Line payment boxes and return this form. Once you are registered you will receive payment notifications by email and we will do the rest. 3.[ ] Direct Debit: Enter goo.gl/wipfVe into your browser. This takes you to our GoCardless secure payment system where you can set up a Direct Debit payment. All you do is tick the Membership Type and the On-Line payment boxes and return this form. Once we receive the form we process the membership subscription and GoCardless will advise you. 4.[ ] Standing Order: If you do not have internet access you can not make Direct Debit payments. In this case you have to set up a Standing Order. Tick this box and we will post you a form pre-printed with the correct payment options, simply complete your bank details, sign and post to your branch.

To cancel your membership at any time please write to the BNTVA and post to “Freepost BH ASSOCIATES” If you make payments by Standing Order and wish to end your membership, it is your responsibility to write to your bank and cancelling the Order. The BNTVA does not accept any liability to refund monies where orders have not been cancelled. If you pay by Direct Debit the BNTVA will cancel your Direct Debit on receipt of your resignation letter. Membership Terms and Conditions. BNTVA Constitution, Data Protection Statement and all other controlling documents are available on www.bntva.com

Membership form 2017  
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