I.A.C - membership application

The Film & Video Institute

membership application - please print and send by snail mail

Surname ..........................................................................

First name .......................................................................

Name of spouse ............................................................

No. of children (under 18) ...........................................

Address .........................................................................

.........................................................................................

Post code ...........................

Telephone (Work) ...............................................................

Telephone (Home) ...............................................................

Date of Birth .....................................................................

TYPE OF MEMBER

Please tick appropriate box:*

Full Member	£24.00	*
Full Member (age over 65)	£20.00	*
Youth Member (17-21 years of age)	£12.00	*
Affiliated Society	£24.00	*
Associate Member (Members of Affiliated Societies only)	£21.00	*
Associate Member (age over 65)	£15.00	*
Junior Member (Under 17 years of age)	£6.00	*
Overseas Member or Society	£24.00	*
Family Membership	£36.00	*
Family Membership (over 65)	£32.00	*

Email address (if you have one!):

OFFICE USE ONLY

Internet form

Membership No.

Cov:

Deed of Covenant

If your income is taxed and you sign the simple deed below, the IAC can recover from the Inland Revenue the income tax which you will have paid on the amount of your subscription.

If you do not pay tax but your spouse does, he/she can pay your subscription and sign the deed and the IAC will benefit.

For example, if tax is 25% £22.00 paid to IAC is worth £29.33. The "Bonus" of £7.33 is allowed because IAC is a registered charity and charities are not liable for income tax.

All that is necessary is for the deed to be completed with the signature witnessed by anyone, including a spouse, and sent to IAC office at the address below.

Deed of Covenant

To Institute of Amateur Cinematographers Limited
24c, West Street, Epsom, Surrey, KT18 7RJ.

I (Full name in capitals) ..........................................................................................................................

of (address) .............................................................................................................................................

....................................................................................................................................................................

Promise to pay you during my lifetime such sums as, after deduction of income tax at basic rate for the time being in force, amount to £.......................( Please insert the amount of your sub) or its equivalent to the annual membership subscription payable to the Institute at the date on which payment is due each year from the date shown below, provided that I may revoke in writing this Deed of Covernant any time after the expiry of four years from this date.

Signed, and deliveredby me this................day of....................19.........

Signature............................................................................

in the presence of (Signature of Whitness)....................................................................................

Address of Whitness..........................................................................................................................

................................................................................................................................................................

Instruction to your Bank to pay Direct Debits

Please complete parts 1 to 4 to instruct your bankto make payments directly from your account, then
return the form to the Administrative Secretary, IAC, 24c West Street, Epsom, KT18 7RJ.

Identification Number 940356

To the Manager ...............................................................................Bank ..................................................................................... ..................................................................................... .....................................................................................	4. I instruct you to pay Direct Debits from my account at the request of the IAC. The amounts are variable and may be debited on various dates, but I understand that the IAC may change the amounts and/or dates only after giving me prior notice.
1.Please write the full postal address of your bank branch in the box above. Branch Sorting code ...............--..............--.............. 2.Name of account holder (in BLOCK LETTERS) ................................................... 3.Account number ................................................... (Banks may refuse to accept instructions to pay direct debits from some types of accounts)	PLEASE CANCEL ALL PREVIOUS STANDING ORDERS IN FAVOUR OF THE INSTITUTE OF AMATEUR CINEMATOGRAPHERS (Account no. 80476021) I will inform the bank in writing if I wish to cancel this instruction I understand that if any direct debit is paid which breaks the terms of this instruction, the bank will make a refund. Signature.............................................................................. Date......................................................................................
Originator's reference............................................ To: The Administrative Secretary, IAC, 24c West Street Epsom, Surrey KT18 7RJ After completion, the bank branch should detach the lower part of the form and return it to the IAC.	FOR BANK USE ONLY

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