Download an application form - Compton Verney

Application form
Please print clearly in BLOCK CAPITALS and return to:
Compton Verney, FREEPOST NAT9520, Warwick CV35 9BR. No stamp required.
Your details
Title______________ First name ________________ Surname________________________
Address______________________________________________________________________
____________________________________________ Postcode _______________________
Telephone (daytime)_________________________ (evening)________________________
Email________________________________________________________________________
We will store your contact details on our database in order to process your subscription. We would like to send
you regular information about Compton Verney. If you agree to this, please tick the box next to the way you
would prefer to be contacted: By post By email
I/We would like to join Compton Verney and pay the annual subscription as:
Season Pass holder
Patron
Adult £12
Joint £22
Name for second card:
________________________________
Family £24 (two adults and up to
four children aged 5-16)
Child £5
Name of child/children:
________________________________
________________________________
________________________________
Member
Individual £26
Joint £48
Name for second card:
________________________________
Family £52 (two adults and up to
four children aged 5-16)
Supporter
Individual £200
Individual £800
Additional name on card:
________________________________
Benefactor
Individual, bronze level £2,000
Individual, silver level £5,000
Individual, gold level £10,000
Additional donation
£ ______________________________
For Benefactors, Patrons and
Supporters only
Please specify by what name(s) you wish
to be listed in our publications and
(Benefactors and Patrons only) on our
acknowledgement wall in Compton
Verney’s entrance hall:
__________________________________
OR tick here if you wish to remain
anonymous
Gift Aid and VAT Information:
Gift Aid can add 25% to the donation portion of your fee which is split
between a voluntary donation and a payment for benefits as follows
(benefits/donation): Supporter £110/£90; Patron £210/£590;
Benefactors: Bronze £210/£1,790; Silver £380/£4,620; Gold £680/£9,320.

If you wish to support one of Compton Verney’s Four
Pillars, please tick the fund below that you find of interest:
The Exhibition Fund for our exhibitions and collections
The Adam Fund for our built heritage
The Inspire Fund for art education
The Capability Fund for our historic landscape
Would you like more
information on:
Legacies
Volunteering
Adopt a Tree
Corporate membership
Gift Aid declaration
If you are a UK taxpayer, you can make your donation worth 25% more to Compton Verney at
no extra cost to you by signing and dating the following statement. If you are applying to become
Joint Season Pass holders or Joint Members, we need both adults to complete this declaration.
I/we would like Compton Verney House Trust to reclaim tax on all qualifying donations and
membership I/we have made in the previous six years and on or after the date of this declaration.
I/we confirm that I/we have paid an amount of UK income tax or capital gains tax at least equal
to the amount of tax that all the charities that I donate to will reclaim on my gifts for that tax year.
Signature(s) ____________________________ _______________________________
Print name(s) ____________________________ _______________________________
Date ____________________________ _______________________________
NOTES:
1. Compton Verney House Trust is a
registered charity number 1032478.
2. You can cancel this Gift Aid declaration
Payment details
at any time by notifying Compton Verney.
3. Please let us know if you change your
name or address. 4. Please let us know if
you no longer pay an amount of income
tax or capital gains tax equal to the
amount of tax that all the charities you
donate to will reclaim on your gifts for
that tax year.
Please charge the sum of £_______ to my Visa/MasterCard/Maestro (circle one)
Card number
Start date
Expiry date
m m y y m m y y
Issue number (Maestro) Security code
I enclose a cheque for £_______ made payable to Compton Verney House Trust
I enclose a CAF cheque for £_______ made payable to Compton Verney House Trust
Please note that CAF cheques may be used for Season Passes, Membership, the voluntary donation
element of Supporter, Patron and Benefactor subscriptions and additional donations.
Patrons and Benefactors are welcome to pay their annual subscription through
quarterly or annual Direct Debit payments. Please just ask a member of staff,
call 01926 645 547 or download a form from www.comptonverney.org.uk/support_us