THE JAPAN SOCIETY MEMBERSHIP 2024
Please print this form single-sided only, then select the membership level you require,complete your personal and payment details*, sign by hand and return by post to:
The Japan Society - 13/14 Cornwall Terrace, London NW1 4QP* Please read our privacy policy on our website (https://www.japansociety.org.uk/privacypolicy). By filling this form, you state that you have read and agreed toour privacy policy. If you agree below, you will receive information about Japan Society’s event and activities by post and/or email.

PERSONAL DETAILSDIRECT DEBIT MEMBERSHIPINDIVIDUAL STANDARD
Individual(DD discount rate) - £42.50

INDIVIDUAL DONORDonor - £100Principal Donor - £250

(DD discount rate) - £58.50

Family

Benefactor - £500

Bulletin UK - £25

Principal Benefactor - £1000

Bulletin Overseas - £35

Patron - £2500

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GIFT AID (only applicable to current UK Tax payers)

Title .................................. Name ..................................................................
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Address ...........................................................................................................
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Consent to Gift Aid and your support to the Japan Society can beenhanced at no further cost to you – Gift Aid is reclaimed fromthe tax you pay. You need consent only once to allow the SocietyTel. ....................................................................................................................

to claim Gift Aid for each year of your membership.

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Email address (es) ........................................................................................

Name(s) of family members (family membership only)
Gift Aid Declaration

I would like the Japan Society to reclaim the tax on any
qualifying subscriptions and donations made for the four years
prior to this date and all further gifts I make from the date of thisdeclaration until I notify the Society otherwise. I am a UK taxpayer
and understand that if I pay less Income Tax and/or Capital Gains
Tax than the amount of Gift Aid claimed on all my donations in
any tax year it is my responsibility to pay the difference.

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How would you like us to send you information about Japan
Society Events and Activities? Please tick all that apply.
Signature

Post

EmailHow did you find out about the Japan Society?
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DateInternet
Japan Society member
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 Japan Society event
 Word of mouth OtherInstruction to your Bank or Building Society
Please pay the Japan Society Direct Debits from the account detailed in this Instruction subject to thesafeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with theJapan Society and, if so, details will be passed electronically to my Bank/Building Society.
Name(s) of Account Holder(s) .................................................................................................................................................................
Bank/Building Society account number

Branch Sort Code

To: The Manager Bank / Building Society ...........................................................................................................................................
Address of Bank ......................................................................................................................................................................................
Signature .................................................................................................. .Date .....................................................................................
For Japan Society office use only
Service User Number7

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Reference

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