NEW Membership Application Form

Membership is from 1st May each year

The Museum is registered with the Information Commissioners Office and complies with the Data Protection Act. Information you provide may be retained in any form. The Museum does not provide any personal information to other organisations. I agree to receive communication from the Rayleigh Town Museum in relation to all Museum activities by means of the contact details enclosed onthis form.

All fields marked with * are required and must be completed

Your Choice of Membership*

Single Membership - £13.00Family Membership at same address - £18.00

Title*

First Name*

Last Name*

Email Address*

Address*

Street/Road

Street Address Line 2

Town

Post Code

Your Contact Number*

Additional Family Member included in your application

First and Last Name of Family Member

Your Chosen Method of Payment, please check box, as appropriate*

Internet Bank TransferStanding OrderCash/Cheque

INTERNET BANK TRANSFER:

Please pay to:

Rayleigh Town Museum

Account Number: 43990869

Sort Code: 20-70-93

Please give your Last Name as the "Reference"

STANDING ORDER

Please download the the Standing Order Form, complete it, commencing 1st May, 2026, sign it and hand in or send to Rayleigh Town Museum.

To download a copy of the Standing Order, select HERE.

PAYMENT BY CASH OR CHEQUE

For payment by Cash, please bring into the Museum and payment by Cheque either bring into the Museum or post it to Rayleigh Town Museum, 1st Floor, 91 High Street, Rayleigh SS6 7EJ

Do you wish to Add Gift Aid, we can claim an extra 25p per £1 from the Government?*

YesNo

GIFT AID DECLARATION - If you are a UK tax payer then please complete the Gift Aid Declaration

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6th April to 5th April) that is at least equal to the amount of tax that all the Charities or Rayleigh Town Museum Friends Group that I dontate 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 evey £1 that I gave up to the current tax year on 5th April and will reclaim 25p of tax of every £1 that I give on or after 6th April.

Title

First Name

Last Name

Signature

Just Type your Name into the above field/box

PLEASE NOTIFY THE MUSEUM IF YOU:

Want to Cancel this declaration
Change your Name or your Home Address
No longer pay sufficient tax on your income and/or Capital Gains

Please call the Rayleigh Museum on 01268 773535 or email: friends@rayleightownmuseum.org

Friends of Rayleigh Town Museum Membership Application Form