Friends of the Lake District | Joint Life Membership (over 65s)

Title *

First name *

Surname *

Date of birth *

Address *

Postcode *

Telephone number *

Additional telephone number

Email address *

Confirm email address *

Can we claim gift aid on your donation? Tick here if you are a tax payer and would like us to reclaim the tax on this payment. *

YesNo

Partners gender *

MaleFemale

Partners first name *

Partners surname *

Can we claim Gift Aid on your donations?

YesNo

Name of Joint Member we can claim Gift Aid against?

What prompted you to join?

Campaign - please state below which oneLeaflet in Cumbria LifeArticle in the newspaperLeaflet in Lakeland Walker Friends of the Lake District magazineFriends of the Lake District e-newsPlanning application - please state which onePicked up a leafletOther

Other (please state)