Member Registration – Arthritis Action

Title*

Name*

First Last

Date of birth*

Date Format: DD/MM/YYYY

Phone

Email*

Mobile

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership Options*

Annual
Lifetime Membership

*Annual - £20.00 per year or £15.00 per year if you pay by Direct Debit
* Lifetime Membership - £100.00

How would you like to pay?

Optional Donation

Please enter an optional donation amount here

One off Donation
Annual Donation

One off Donation

There is no obligation to make a donation although a voluntary contribution will help the charity to reach more people with arthritis.

Gift Aid

Yes, I am happy for all gifts of money that I have made to Arthritis Action, past, present and future to be treated as Gift Aid donations

I confirm I’m a UK taxpayer and have paid sufficient tax (income and/or capital gains tax) on all my donations to all charities and CASCS to cover the tax that will be reclaimed on my donations. I understand other taxes such as council tax and VAT do not qualify

Total Amount Payable

Price: £ 0.00

I am becoming a member of Arthritis Action because

How did you hear about Arthritis Action?**

Data Protection Policy

Please tick this box if you do not want to receive marketing and appeals

Arthritis Action will hold the information you have given in this form and will use it in connection with your membership to keep you informed about the activities of the Charity and appeals. A copy of our Data Protection policy is available on request. At all times we aim to comply with the Data Protection Act 1998. By filling in your email address, you are agreeing to be contacted in this way.

Account Name

Sort Code

Account Number

Total Annual Fee

Total Annual Fee (Direct Debit)

Total Lifetime Membership Fee

One Time Fee for Donation

Price: £ 0.00

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Membership Type

Password

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Phone

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