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Application to be a Sheffield 50+ member

Membership application form

Full Name:   D.O.B
Address Line 1:
Address Line 2:
Postcode:   Gender:
Telephone (Home):   Telephone (Work):
Email:
Disabled:      
Ethnicity:   Please Specify:
Sexual Orientation:   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.