Membership Application Form

DETAILS

Name:

Address:

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Telephone: Mobile:

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Print Name:

Indicate Category of Membership

Form of Payment

(You may pay by cheque or postal order. Please complete the details below)

Payment Due:

Membership Subscription:

Additional Donation:

Total Payment:

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I / We enclose my / our cheque / postal order for made payable to USPCA. I apply for membership and I will observe and be bound by the Society’s Articles of Association.

I declare that I intend any donations I make now and hereafter to Ulster Society Prevention of Cruelty to Animals (USPCA) to be GIFT AID DONATIONS.

I would like Ulster Society Prevention of Cruelty to Animals (USPCA) to reclaim the tax I have paid on these donations, until such time as I give notice in writing.

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Date:

If you would like information on fundraising opportunities within the USPCA please tick here and we will send you details. I am not happy to be contacted by email or text. Please tick here. 

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Your support is necessary to ensure the USPCA continues to fulfill its core objectives of Investigating Cruelty and the Relief of Suffering.