Alexandra Palace Organ Appeal
Alexandra Palace, Wood Green, London N22 4AY
Registered Charity No. 285222
Patrons: His Grace The Duke of Marlborough, Dr Roy Massey, Carl Jackson

Trustees: Graham Hawkes ( Chair), Paul Smith (Secretary), Michael Rhodes ( Treasurer)
John Apperley, Hugh Macpherson, David Moores, John Pryer, Roger Tucker, Stephen Walmsley

APPLICATION FORM TO BECOME A FRIEND 2008– Standing Order
Please complete the form below and send to :- The Treasurer,
Alexandra Palace Organ Appeal, P.O. Box 2411, Stoke-on-Trent, ST4 5XA
( Please do not send to your bank )

Please make one payment now, and thereafter pay annually on 1^st January to the Alexandra Palace Organ Appeal, Co-operative Bank, Olympic House, 6, Olympic Court, Salford, M5 2QP

Sort code: 08-92-50 Account No 65031412 the sum of £ 15 or …………..( Please amend if you wish to make a donation in addition to the minimum subscription of £15).

Name of your Bank /Building Society ………………………………………………………….

Address of Bank / Building Society …………………………………………………………….

………………………………………………………. Post code……………………………..

Name( s) of account holder ( s) ( Please print) ………………………………………………

Your account number …………………………………….. Sort code ………………………..

Your signature …………………………………………….. date ……………………………….

Your address ………………………………………………………………………………………

………………………………………………… Post Code ……………………………………….

Telephone number ………………… Email address ………………………………

GIFT AID Please complete the following if you would like your subscription to be classed as gift aid which will enable the Alexandra Palace Organ Appeal to reclaim income tax .

I would like the amount I have given for subscriptions and donations to the Alexandra Palace Organ Appeal since April 6^th 2007, and all future donations & subscriptions to be treated as Gift Aid donations. I can cancel this at any time by notifying the charity.

Signature…………………………………………….. Date ……………………………….

Forenames ………………………………Surname ………………………………

Form 1 Iss 5