GMI Membership & SO Form

GMI Membership Application Form

The G.M.I. is dependent on your membership fees to survive. Please complete all questions.
Member's Name *

First Name Last Name

Address *

E-mail *
Land Line Number

Area Code Phone Number
Mobile Number
Membership Type *
Please select
Please join the monthly Prize Draw *

Yes please, I want the chance to win half the monthly pot and support the Institute (£1/month) No thanks.
Make an additional monthly donation? *

No thanks £0.50/month £1/month £2/month
Subtotal Membership
Subtotal Prize Draw
Subtotal Donation
Total Monthly Donation
£/month
Gift Aid Declaration

Tick to confirm if the member is a UK tax payers and you would like the G.M.I. to treat all the membership donation and any Prize Draw entry you make, until you notify us otherwise, as Gift Aid donations
Standing Order instructions to your bank
Name of Bank / Building Society *
Account Name *
Sort Code *
Account Number *
Monthly Standing Order to Start On *

Day Month Year Date Picker Icon
Standing Order Confirmation *

By ticking this box you confirm that the Glencairn Memorial Institute can collect from this bank account, by standing order, on a monthly basis, the "Total Monthly Donation" amount shown above until you cancel it with your bank.
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GMI Membership Application Form