Ecclesbourne Valley Railway Association

Type of membership (per year):-   Standard (£12)      Senior Citizen (60+) (£6)      Junior (under 18)(£6)   
                                                    Joint (2 Standard and up to 3 Junior - all living at same address) (£25)

Type of membership (Single payment):-   Life  (£250)                   Senior Life  (£125)

Address:-  

Postcode:         Tel.No:      

Occupation:    Optional

email:-       

Do you wish to join the Community E-Group    Yes  No

Would you like to support EVRA through Gift Aid? If you pay income tax or Capital Gains tax, EVRA may (subject to your agreement) recover from the Inland Revenue the amount of tax you pay on your subscription and any donations. This will increase the value of your subscription by 28%
                Please reclaim tax on all donations and subscriptions I make
                from the date I submit this form until further notice         YES   NO  

You may submit this form by using the 'Click to Send ' box below. This will be acknowledged by email but you must then send by normal mail a cheque for the appropriate amount and made out to 'Ecclesbourne Valley Railway Association' to
Mr Vince Morris, Membership Secretary, 530 Kedleston Road, Derby, DE22 2NG
Please write 'applied by email' on the back of your cheque.

   Please note: Membership will be deemed PROVISIONAL upon receipt of this form. You will be required to send a cheque to the membership secretary whereupon you will receive all benefits of membership.