Membership Application Form

Your name

TitleFirst NameLast Name

Your email address

example@example.com

Your phone number

Phone number

Your address

Address 1

Address 2

TownCounty

Postcode

Choose your membership

Single membership

Annual subscription

£12.50 for each year

Joint membership

Annual subscription

£20.00 for each year

Email

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Billing Adress

Your billing Address

Address 1

Address 2

TownCounty

Postcode

You have applied for Joint Membership. Please provide the names for each member:
Member 1: .
Member 2: .

Gift Aid

Add 25% more to your donation at no cost to you. A Gift Aid declaration allows Bexhill Maritime (CIO, Assoc) to claim tax back on eligible donations. It means that for every £1 you donate to Bexhill Maritime (CIO, Assoc) we can claim back 25p, at no extra cost to you.

Gift Aid Declaration

By ticking the "Yes" box, I agree I would like Bexhill Maritime (CIO, Assoc) to reclaim the tax on all qualifying donations I have made, as well as any future donations, until I notify them otherwise. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year I may be asked to pay any difference. I understand that Bexhill Maritime (CIO, Assoc) will reclaim 25p of tax on every £1 that I give.

Choose your membership*

Choose your membership