KPCSG

    Kidderminster Prostate Cancer

    Support Group for Worcestershire

 

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Membership of the Kidderminster Prostate Cancer Support Group

Benefits of Membership

Annual joining fee of only 5

Mutual support from other group members, both for those recently diagnosed and those on the recovery path

An up to date awareness of men's  healthissues gained from the distinguished speakers at our quarterly meetings

Regular information and news feeds from the quarterly supporter and website.

JOIN NOW

Please complete the attached form and send it to our membership secretary with the 5 registration fee.

 

KIDDERMINSTER PROSTATE CANCER SUPPORT GROUP

SATELLITE MEETINGS

We are keen to support satellite group meetings in other towns in Worcestershire and would
welcome anyone who would be willing to organise and chair one of these meetings.

A member or members of the group would be willing to attend and in the future
to arrange for speakers to attend if that is what you would wish.

The group would gladly fund any incurred costs for room rental, advertising,  light snacks and drinks (not alcohol).

 

Please fill out your details below if you would be willing to be involved in arranging an event in your area
and any suggestions of venue etc. and return to:  

Mary Symons, Clinical Nurse Specialist Survivorship Programme,
Kidderminster Treatment Centre, Bewdley Road, Kidderminster, DYLL 6RJ.

 

Name:  ________________________________________

Address: ______________________________________________________________________

Venue: ________________________________________

Funding requirements ___________________________________________________________

 

To Print the forms, make sure your printer is on, then hold down the Ctrl key and press the 'P' key

 

 

Prostate Cancer Support Group

(Kidderminster & District)

 APPLICATION TO BECOME A MEMBER

A. The Prostate Cancer Support Group invites you to become a member with an Annual Subscription of 5 per member (includes partners) being paid by Standing Order. All you have to do is to complete parts A & C of this form. However, if you are a Tax Payer, then we can reclaim the Tax element of your Subscription if you also complete part B. You can cancel your Standing Order and declaration at any time by writing to our P.O. Box 3854 address.

Name(s) ...........................................................................................   

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

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

Post Code  .....................................  Telephone Number  ...................................................  Email Address  .......................................................

Please ensure you complete the Standing Order Form C, and post parts A & B to our PO Box 3854 address or by handing it to a Committee Member, or bring it to a Town Hall Meeting.

The Standing Order part C should be cut off at the perforation and handed in at your bank.

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B. Gift Aid

I,  .................................................................................................................  (Full Name)

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

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

Post Code  .................................................... 

Wish my payment of and future payments to the Prostate Cancer Support Group (Kidderminster & District) to be treated as a Gift Aid donation. I declare that I am a UK Taxpayer and aware that I must have paid enough UK Income Tax or Capital Gains Tax to cover all my annual charitable donations. If there is any change to the above statement, please contact the Treasurer by writing to our P.O. Box 3854 address.

 

Signature  ..................................................................................................   Date  .........................................................

 

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C. Standing Order                                                                                        Date  .........................................................

To : The Manager  .........................................  Bank / Building Society    Sort Code      -     -

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

Please pay the annual subscription of 5.00 payable on the 3rd. January and annually thereafter to the Prostate Cancer Support Group,
Kidderminster & District, Acct. No. 01846443, Sort Code 30-94-70, at Lloyds TSB Bank, Vicar Street, Kidderminster, charging the payment to

 

my/our Account Number  ...................................................Print Account Name  ................................................................................................

 

Signed........................................... Reference: PCSG

 

PO Box 3854, Kidderminster, Worcestershire  DY11 5WP         

Registered Charity      1100718

 

 

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