Membership Application

Please complete the form to become a member of the British Society for the History of Pharmacy

First Name

Last Name

Title

Email Address

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

Areas of interest

How would you like to receive the Journal and mailings?

Digital Only

Harcopy Only

Both

I wish to pay by:

PayPal (Button will appear on next page)

Bank Transfer (Email treasurer@bshp.org)

Gift Aid (Optional)

If you are a UK tax payer and complete the information below the BSHP can reclaim the tax you have paid on your subscription.

Please treat as a Gift Aid Donations (please tick all boxed you wish to apply)

All qualifying gifts of money made today

In the past 4 years

In the future

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 28p of tax on every £1 that I gave up to 5 April 2008 and will reclaim 25p of tax on every £1 that I give on or after 6 April 2008.

Please notify BSHP if you:
a) Want to cancel this declaration
b) Change your name or home address
c) No longer pay sufficient tax on your income and/or capital gains.

Your Signature (For Gift Aid Only; Please use cursor to write)