Becoming a Life Patron of Adderbury Library

LIFE PATRON APPLICATION FORM

I/we wish to become a Life Patron of FOCAL at a cost of:-

£1,000.00 as a one-off payment per person or couple

 

NAME(S)
ADDRESS
TELEPHONE
EMAIL

By completing this form, you give permission for Focal to hold your personal information. We will only use this information to inform you of news about the Library and Friends events, appeals and renewals of memberships. You may withdraw this consent in writing at any time.  We take your privacy seriously and store your data securely.  Your data will not be shared with any other organisation.

Payment Options

– I enclose a cheque for £1,000.00 made payable to Focal

Please treat as a Gift Aid donation (from taxed income)

Tick the box if you wish to do this

Confidentiality:

I/we wish/do not wish my/our name(s) to be entered on the Patron’s Roll in the library *

*Please delete as appropriate

 

Signature:

 

  Date:  

 

Financing policy:

Focal is very grateful for your generous decision to take out a Lifetime Patron Membership. We are conscious of the need to maintain a long-term and viable future for our library and our policy for lifetime patron membership is to amortise your one-off payment over ten years.

In other words, your membership subscription will be credited to our income account at the rate of £100 pa.