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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.

There are three ways to pay your BNTVA Membership: 1.[ ] Cheque Payment: Make cheque payable to BNTVA and return with this form. 2.[ ] On-Line Payment: Enter 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: If you are not registering on-line and wish to pay by Direct Debit Complete the form below and return to us. We will set up your Direct Debit and send you the confirmation. Direct Debits are covered under Guarantee view the full Guarantee at Direct Debit Mandate – only put account details in here if you are asking the BNTVA to set-up the direct debit (Option 3)

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Account No Account Name This Page will be securely destroyed once your details have been entered to our systems

Membership Terms and Conditions. BNTVA Constitution, Data Protection Statement and all other controlling documents are available on

Membership form 2017