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Companion Subscription Form

Companion Subscription Form

Membership Form
Companion Number	If you are already a companion and wish to renew your subscription, please enter your companion number.
Companionship Type *	Single Companionships receive one Companionship Card which admits the named adult and two accompanied children up to the age of 17. Couple/Family Companionships receive two Companionship Cards which each admit a named adult and two accompanied children up to the age of 17.

Information About You

Membership Form
Would you be interested in becoming a volunteer?
Title *
First Name *
Surname *
Date of Birth *
Address *
Town/City *
County *
Postcode *
Country *
Email *
Telephone *
Password *
Confirm Password *
Skills Offered
Would you be interested in joining our national network of Publicity Volunteers?
How did you hear about Chalice Well and why have you decided to become a Companion?

Information About Your Partner

Membership Form
Title *
First Name *
Surname *
Date of Birth *

Keeping You Informed

Please keep me informed of forthcoming events
Send me mailings from the Chalice Well Trust

Make A Donation

Gift Aid	Please help. Chalice well is a registered charity and most companions already pay their subscriptions using gift aid, which helps us make their subscription go further at no extra cost to themselves. Gift aid is a government scheme where charities can reclaim money on your contribution from the HM Revenue and Customs. If you are a UK taxpayer, we can reclaim 25 pence for every £1.00 you give us. For example for a UK Companionship of £21.00, Chalice Well can claim an additional £5.25 from the government.
Donation £	If you would like to make a donation to the Chalice Well Trust, then please enter the amount you would like to donate. Don’t forget to Gift Aid it!

The Chalice Well Trust
Chilkwell Street,
Glastonbury, Somerset
BA6 8DD

T: 01458 831154
Registered Charity Number: 1147343
Company Registration Number: 08048023

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