Evangelical Alliance Membership Renewal

Membership Number:
if known

Title:*

First Name*

Last Name*

House number / name:*

Address:*

Address: 

Town / City:*

County:

Postcode / ZipCode:*

Country:*

Email address:*

Telephone number: 

Mobile number: 

Date of Birth: 

Amount:* £ 

Gift Aid: Explanation (opens in a new window)

  

I understand that I must pay an amount of United Kingdom Income Tax and/or Capital Gains tax that is at least equal to the tax that the charity reclaims on my donations during the tax year, (currently 25p for each £1 you donate).
I want the Evangelical Alliance to claim tax on this donation

  

and all my subsequent donations

  

and any donations made since 1st April 2007.

Church Membership Number:
if known

Church Name:*

Church Postcode:*

Your Details

Title:*

First Name:*

Last Name:*

Your Email address:*

Your Telephone number: 

Your Mobile number: 

Donation Amount:* £ 
We would value you making a donation of at least £1 per attendee with a minimum donation of £80 per annum.