NLCA 500 Club Membership Form

I would like to apply for a share or shares in the 500 Club, the number as noted below, at a cost of £2.50 per share each month (for 12 months minimum), or £30 per share annually.

(For example, if you are buying two shares and wish to pay monthly it would be £5 per month for 12 months, or £60 as one annual payment for your shares.)

Number of Shares Required

Payment Method - Please select your preferred way to pay:*

Annual or monthly online (BACs) payment (Payment to: Nether Lochaber Community Association, Account Number: 16859260 Sort code: 80-22-60)Annual cheque (payable to Nether Lochaber Community Association. We cannot accept monthly cheques.)Monthly/Annual* Standing Order

All shares paid for by the 15th of the month are eligible for that month's draw.

I confirm that, by making a payment, I accept the ‘NLCA (SCIO) 500Club Rules’. (Click to open in a new tab)

Name*

First NameLast Name

Email*

example@example.com

Postal Address*

Street Address

Street Address Line 2

TownCounty (Optional)

Post Code

Phone Number

Please enter a valid phone number.

Date

If you are buying shares for more than one person please add the names of all shareholders here and the number of 500 Club shares you are purchasing that you wish to allocate to each.

e.g. from 4 shares bought, Jock MacNeil - 2 shares, Jean MacNeil - 2 shares

Data Protection: the information you have supplied will be used for the purpose(s) for which you have provided it. This data will be maintained in accordance with the Data Protection Act 1998 and will not be passed on or sold to any other organisation without your prior approval, unless there is a legal requirement to do so.

Declaration*

I agree to the use of my personal data as detailed above:

What happens next?

When you submit this form please make arrangements for payment as chosen above. Once that's done, please drop a line to Gordon Mac Intyre at 500club@netherlochaber.org.uk to let him know the details and he will assign the numbers accordingly.

You will be given a Unique Number for each share purchased and this number will remain associated to your share permanently, whether the share is your own or gifted to another person. Your number(s) will be entered in the next draw.

Draws take place on the last weekend of each month.

Winners will be notified within one week of the draw.

If you have any queries, please contact us.

Thank you – and good luck!

NLCA is a Scottish Charity Registered Number SC047546, registered office: Brudair, Bail Ur, North Ballachulish, Fort William PH33 6SB

NLCA (SCIO) 500 Club