London Film Society Donation Form

The London Film Society Support the London Film School and get an inside look at the future of independent film.

I would like to join the London Film Society as a: Individual - £83 by monthly instalments via standing order - £1,000 per year in one payment

Couple - £166 by monthly instalments via standing order - £2,000 per year in one payment

1. Preferred method of payment: please tick the appropriate box Cheque - Please make cheques payable to the The London Film Society Credit/debit Card Mastercard

Visa

Switch

Delta

Solo

JCB

Please debit my account for £__________________________________________________ Cardholder name ____________________________________________________________ Card Number Security code__________________________ Expiry date____________________________ Issue No – Switch only_____________________ Signature_______________________________________Date________________________ Standing Order Mandate – please fill out the form below Bank Name and Address……………………………………………………………………………….. ……………………………………………………………………………………………………………..

Account no……………………………………Sort code……………………………………………….

Please pay to The London Film Society, sort code 16-00-38, account no. 11308845 Drummonds AT THE ROYAL BANK OF SCOTLAND plc, 49 Charing Cross, London, SW1A 2DX the

sum of £………………………………………...

Annually

Monthly

Amount in words………………………………………………………………………………………….

Date of annual payment………………………………………………………………………………...

I hereby authorise you to set up this standing order payment on my account until further notice

Signed………………………………………………………….Date…………………………………....

The London Film Society, 24 Shelton Street, London WC2H 9UB +44 (0) 203 3271489 Registered as a charity in England and Wales: 1146656 - www.londonfilmsociety.org.uk

2. Your details Title............................. First name................................................................................................

Last name.....................................................................................................................................

Home Address.............................................................................................................................. ………….………………………………………...……….Postcode..…………………….…………….

Tel…........................................................Mobile...........................................................................

Email.............................................................................................................................................

Make your gift go even further As a UK tax payer, you can increase the value of your gift to The London Film Society at no extra cost to you. Consent to Gift Aid and The London Film Society can reclaim the tax already paid on your donation.

Gift Aid declaration

☐(Please tick) I would like The London Film Society to reclaim Gift Aid on any membership subscriptions or donations that I have made since 28 March 2012, and that I make now or in the future, until I notify you otherwise.

For the charity to claim Gift Aid, your UK income tax or capital gains tax payments must at least equal the amount this charity and any other charities or Community Amateur Sports Clubs will claim in each tax year (25p for each £1 you give). Please inform us if your circumstances change.

☐No, thanks, I do not wish to Gift Aid my support to The London Film Society Please note: We are obliged by HMRC to make it clear that the donation component of £794 (individual) or £1,588 (couple) paid my Members is voluntary and that it is possible to purchase the Membership without the cost of this donation, at a cost of £206 (individual) or £412 (couple). If you wish to do this please contact Alex Duxbury at a.duxbury@lfs.org.uk

Signed……………………………………………………………Dated………………………………..

Please return this form to the address below.

If you have any queries, please don’t hesitate to contact Alex Duxbury at a.duxbury@lfs.org.uk Thank you for your generous support.

The London Film Society, 24 Shelton Street, London WC2H 9UB +44 (0) 203 3271489 Registered as a charity in England and Wales: 1146656 - www.londonfilmsociety.org.uk