Membership application form Full Name: D.O.B Address Line 1: Address Line 2: Postcode: Gender: Male Female Transgender Telephone (Home): Telephone (Work): Email: Disabled: No Yes Ethnicity: Please specify White - British - Irish - Gypsy/Traveller Asian or Asian British - Indian - Bangladeshi - Pakistani Mixed - White and Black Carribean - White and Black African - White and Asian Black or Black British - Black Caribean - Somali Chinese or Chinese British - Chinese - Chinese British Other Ethnicity Groups - Yemeni - Other (please specify to the right) Please Specify: Sexual Orientation: Heterosexual / Straight Gay Lesbian Bisexual Other (please specify to the right) Please Specify: How did you hear about Sheffield 50+?: Sheffield 50+ relies entirely on donations and grants. Would you make a donation to keep speaking up for people over 50 in Sheffield? Any donation is very welcome and will be put to good use. Yes, I would like to help by supporting Sheffield 50+. I have enclosed a cheque of £ made payable to Sheffield 50+ I have set up a monthly/annual standing order to pay £ directly to your bank Account number 20247432 Sort code 08 60 01 I confirm I am a taxpayer and I would like Sheffield 50+ to receive Gift Aid tax on my donation. Alternatively you can make a payment via PayPal by clicking here.