FBRT Friendship Application Form

If you wish to become a Friend of the FBRT, please type in details, print out and sign the form below, and post it, together with your annual subscription of £25, to:

The Secretary, The Francis Bacon Research Trust,
Roses Farmhouse, Epwell Road, Upper Tysoe, Warwick, CV35 0TN, England.

UK subscriptions and donations may be made by Gift Aid if you are a UK taxpayer.

If you wish to pay by means other than a cheque drawn on a UK bank, please contact the FBRT Secretary.

**Printing hint: Select Print Preview in drop-down File menu, click in the text of the form, select 'Only the selected frame' in Print Preview navigation bar (instead of 'As laid out on screen'), then select Print button.
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I wish to be a Friend of the FBRT and enclose a cheque for £25

In addition I wish to be a Benefactor of the FBRT and enclose a donation of
£ 10 £20 £50 £100 £1000 Other

Total Amount Enclosed

I wish to subscribe/donate by means of the Gift Aid scheme and enclose my Gift Aid Declaration

Personal Information
Title
First name
Last name
House/Street address
City/Town/Village
County/State/Province
Postal Code/Zip Code
Country
Phone
Fax
E-mail

Please tick box if you object to other Friends of FBRT being given your details.
Please tick box if you object to other organisations being given your details.

Date

Signature.....................................................................................