ICMG Margate Membership form

MEMBERSHIP FORM

System Member No
RIQ-02

Donation Amount *

Make this donation every month (mandatory)

Name Surname *

Email *

Phone number *

Make this donation every month (mandatory)

Gift Aid (eligible) – I want to add Gift Aid to my donation

Donation summary

Donation amount

—

Frequency

Monthly

Gift Aid

Member No

RIQ-02

Account Holder Name *

Sort Code *

6 digits (e.g. 12-34-56)

Account number *

8 digits