THE ROBEY TRUST LTD

MEMBERSHIP APPLICATION/RENEWAL

2010

Membership subscriptions are due on 1st January.

Membership fee enclosed £

Donation to the Machinery & Equipment fund £ ..............

Please make cheques payable to The Robey Trust Ltd.

Title: Forename:_________________ Surname:____________________

Address:_____________________________________________________________

____________________________________________________________________

____________________________________________________________________

Postcode:_____________________________ Membership Number:_____________

Phone Number:_________________________

E-mail:________________________________

Are you a UK taxpayer? If so, please complete a Gift Aid Declaration

For new members: your new membership card will be sent to you with a 'welcome' pack.

For renewals: your new membership card will be sent to you with the next issue of The Robey Trust Ltd Newsletter. If you wish it sooner, please enclose an SAE for its return.

Please forward to the Membership Secretary:

Mr Peter Dixon

22 Priory Close

Tavistock

Devon

PL19 9DJ

DATA PROTECTION ACT: We advise prospective members that details of Names, Addresses and Membership Numbers are stored on computer in accordance with the DPA. This information will not be divulged to any outside agency.