JOIN MS AYRSHIRE & ARRAN BRANCH TODAY!
Just print off the application form below and return
with your membership fee of £5 to
Mrs C. MacIsaac (Membership Secretary)
30 St Andrews Avenue
Prestwick, Ayrshire KA9 2DY



Membership Application
Ayrshire & Arran Branch[BRANCH WEBSITE FORM]

SECTION A : Name & Address
I would like to join the MS Society Ayrshire & Arran Branchj

Title_____First Name_____________________________Surname__________________________

Job Title / Organisation (if appropriate)_________________________________________________

Address_________________________________________________________________________

________________________________________________________________________________

Postcode__________ Tel _____________________E-Mail ________________________________

Signature________________________________________ Date: __________________________


SECTION B :  About you...all questions are optional
Please tick as appropriate

[__]   I have MS[__] A member of my family has MS [__] I am a health professional

Date of Birth: ______________________

__] Gift Aid: Please tick if you would like your subscription/donation to be subject to Gift Aid
(Note: You must pay an amount of UK income tax and/or capital gains tax that is equal                                       to or more than the amount of tax that we will reclaim).

Please sign ______________________________________ and Date ______________ here
to authorise us to reclaim Gift Aid on your payment.

DATA PROTECTION:
The MS Society will keep your personal information securely and will provide you with the
       services and information associated with our membership and to further our charitable aims.
      Occasionally the charity may wish to pass on your name to selected third party organisations.
Please tick if you do not wish your details to be passed on in this way.  [___]

SECTION C :  Subscription Fee
Annual Membership Fee £ 5.00

Donation to MS Society  £_______[__]I enclose a cheque/PO made
      (optional)      payable to MS Society

     [__]        Cash Payment
   (please do not send cash by post)
Total Enclosed      £_______

PLEASE RETURN THIS FORM TO: 
Mrs C. MacIsaac (Membership Secretary),
30 St Andrews Avenue, Prestwick, Ayrshire KA9 2DY
Registered Charity SCO 16433.