MEMBERSHIP FORM

Brinsley Ford Patron (£1000)

It takes just a few minutes to join!

Firstly, please complete the form on this page, which provides us with the information we will need to serve you as our member. Then, we will send you to the website of our payments provider, GoCardless (for Direct Debits) or Stripe (for Debit/Credit Cards).

We recognise the extraordinary support of our Patron members by listing their names among our major donors at the front of each year's volume. Please let us know on the form below if you would prefer to remain anonymous.

Your privacy matters to us and you may read our data policies here.

ANTI-SPAM CHECK

Please check the box below and complete the puzzle to demonstrate that you are human and not an art historically-minded robot.

YOUR CONTACT INFORMATION

Please tell us your name and address so that we may send you our annual volume and/or any necessary correspondence about your membership. The asterisked fields are mandatory.

First Name

Surname

Title

Suffix

Phone

Address Line 1

Address Line 2

City or Town

County/Region

Postcode or zip

GIFT AID DECLARATION

I want to Gift Aid my donation and any donations I make in the future

I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

MEMBERSHIP LIST

We publish a list of our Patron members and other major donors at the front of each year's volume, as a way of recording the help of those who contribute to the Society's work. As some members prefer to support the Society anonymously, please indicate below if we may include your name in any future list.

You are welcome to publish my name

Please don't publish my name

QUESTIONS OR COMMENTS

IMAGES

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William De Morgan (1839-1917)

Panel of Wall Tiles, 1882-1907

Birmingham Museums Trust