Nottingham Civic Society

I / We would like all donations made to Nottingham Civic Society from the date of this declaration to be
treated as Gift Aid donations until I / we notify you otherwise.

£ ......................................................................

Signed: .......................................................................................... Date: .......................................................

Full name [block letters please]: ....................................................................................................................

Address: ...........................................................................................................................................................

............................................................................................................................................................................

Please return this form to:Mrs L. Irvine, Membership Secretary,
Nottingham Civic Society, 57 Woodhedge Drive, Thorneywood, Nottingham NG3 6LW