Membership Form

MEMBERSHIP FORM 2017

Single Membership 2017 – £30

*** Click here to download the PRINT-AND-POST-MEMBERSHIP-FORM-2017 ***

You must download the form to your computer then open it, before you can automatically fill in the fields prior to printing or emailing.

For posting or returning via e-mail:

This Postal Membership form above is an editable PDF form. You will need to download it to fill in the form using your computer.
You should then open it in Acrobat Reader or your PDF reader program and fill in the fields by typing directly into each one. The fields outlined in red are ‘required’, so need to be filled in before it can be saved.

Once complete, please save and then either print out a copy to post with your remittance or attach it to an email sent to the secretary at
E-mail: membership.LBSGB@outlook.com
or post to: The Membership Secretary, Applegarth, Orchard Grove, Chalfont St Peter, Buckinghamshire, SL9 9EX

To set up your Standing Order you will need to print out the second page of the PDF and send to your bank to process the payment.Alternatively, if you would rather fill in the Membership Form online, please use the form below. Please note, you will still need to print the second page of the PDF if you wish to set up a Standing Order with your bank.

ONLINE MEMBERSHIP FORM

1 FEES: All membership is due for renewal on the 1st January each year. Payment can be made by cheque (Payable to: The
Lusitano Breed Society); For the Breed Society bank details please ask the Membership Secretary. If paying by standing order, please PRINT OUT THE 2nd PAGE OF THE PDF, FILL IN and take it to your local branch (do not send to the Membership Secretary!)

 

Date standing order to leave Member’s account

Amount of standing order payment

Amount of standing order payment

We would greatly appreciate it if all European and Overseas subscriptions were paid by sterling draft or BACS payment. If this is not convenient please contact the Membership Secretary to make other arrangements.

Please TICK the Membership you wish to subscribe to:

single-membership Single Membership £30.00

family-membership Family Membership £50.00

junior-membership Junior Membership £15.00. (18 years and under as of 1 January of the subscription year) D.O.B (junior members only)

overseas-membership Overseas/ EU Membership £40.00

2 MEMBERSHIP:
Are you a new member or renewing your subscription? New MemberRenewing Subscription
If member your membership No:

Please fill in the details below even if you are renewing your subscription as it helps us keep our records updated

Name of account debited:

Mr/Mrs/Miss/Title

Your Name:

ADDRESS:

TOWN/CITY:

COUNTY: POSTCODE:

TELEPHONE:

E-MAIL:

3 HORSE OWNER: How many Lusitanos do you own?

Pure-bred Stallion/Colt: Pure-bred Mare/Filly: Pure-bred Gelding:

Part-bred Stallion/Colt: Part-bred Mare/Filly: Part-bred Gelding:

Other Stallion/Colt: Other Mare/Filly: Other Gelding:

4 How did you hear of the Society?

5 I confirm that I will abide by the rules which the Society may adopt for as long as I wish to remain a member
I agree

If you do NOT wish your contact details to be published in the Society’s List of Members please select here
DO NOTDO publish my details

We would like to save paper where possible by contacting you by e-mail rather than paper mail.
Please tick here if you consent to us doing so (you will still receive your hard copy of Luso News).
NOYES