APPLICATION FOR MEMBERSHIP OF THE PONTYPOOL & BLAENAVON RAILWAY COMPANY OR SOCIETY
I wish to apply for membership of the Company / Society (Delete Inappropriate)
Name:
Address
Post Code:
Phone Number:	Email Address:
Gift Aid - means that you can increase your support by 28% at no extra cost to you. If you are a UK taxpayer
I wish this and further donations I make to The Pontypool & Blaenavon Railway Company ( Charity Registration Number 514809) to be treated as a Gift Aid donation. I understand that I must pay an amount of income tax or capital gains tax at least equal to the tax the charity reclaims on my donation in the year (28%). Please tick this box o
If the applicant is under the age of 18 years then the boxes below must be completed by the applicant’s PARENT OR LEGAL GUARDIAN who should also add the applicants date of birth.
Name of Witness or Parent:
Address and Postcode of Witness or Parent:
Signature of Witness or Parent:		Date:
Please send your application to: Pontypool and Blaenavon Railway, 13a Broad Street, Blaenavon, Torfaen NP4 9ND. Together with your first years annual subscription of £12 for adults or £6 for under 18 years. Further information from: info@PBRly.co.uk or 01495 792263 www.pontypool-and-blaenavon.co.uk

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