applic ation for MEMBERSHIP

I / We would like to join the Portland Village Association.

T y pe O f M em b e r s h i p (Please tick the appropriate box):

[ ] Individual. . . . . . . . . . . . . . . . . . . . . . . . 15
[ ] Individual concession*. . . . . . . . . . . . . . . . . 5
[ ] Couple. . . . . . . . . . . . . . . . . . . . . . . . . 20
[ ] Couple concession* . . . . . . . . . . . . . . . . . . 8
[ ] Local Non-Profit Making Organisation . . . . . . 25
[ ] Small Business (under 10 employees). . . . . . . . 30
[ ] Large Business/Corporate Member . . . . . . . . 100
*over 60s or student under 25

Paym e nt O p tio n s :

[ ] I wish to pay by standing order (see reverse)

[ ] I enclose a cheque payable to the Portland Village
Association
[ ] DEC L ARATIO N please tick this box to indicate that
you do not object to the Portland Village Association holding
your membership details on computer. The Association will
not disclose this information to any other party.

Membership form
Portl and Vill ag e A ssociation
82c Portland Place
London W1B 1NS

D eta i l s :

Title........................................Surname...........................................
First Name.......................................................................................
Partners Full Name........................................................................
(Joint member ship only)
Organisation and position.............................................................
(Business membership only)
Address............................................................................................
Postcode............................Telephone...........................................
E-mail...............................................................................................
Signed..........................................Date...........................................

Co n tac t:

info@portlandvillage.co.uk
www.portlandvillage.co.uk

Portl and Vill age

A ssociation

Objectives

STANDING ORDER MANDATE

To th e m a n ag e r

Your bank.........................................................................................
Branch name...................................................................................
Branch sort code [

][

][

Branch address................................................................................
..........................................................................................................
..........................................................................................................

Portland Village is a surprisingly calm and

friendly area in which to live, and yet, it is
an important business and communication
hub with a vibrant restaurant scene
and excellent local amenities. With a
rich local history, important national
institutions and adjacent to Regents Park,
it has a wonderful character and feel.

The Portland Village Association is a

not for profit, non political voluntary
organisation collaborating with The
Marylebone Association to further
enhance Portland Village as a wonderful
place to live, work and visit.

Preserve a lively community

Link local residents and businesses
Coordinate the marketing of the area
Enhance amenities
Furtherance of the greening
of the streets
Promote and project the interests of
residents, businesses and stakeholders
Consult local government
on issues of concern
Work with neighbouring communities
Promote safety and security

Postcode..........................................................................................
Please pay from Account No........................................................
the sume of .........................................to the order of Portland
Village Association Ltd, Account No. 91564080, HSBC,
117 Great Portland Street, London W1, Sort code 40-03-15,
quoting
Name...............................................................................................
Organisation...................................................................................
Postcode..........................................................................................
upon receipt of this order, and annually on the anniversary of
this date, until the Order is cancelled by me in writing.
Signed..............................................................................................
Date..................................................................................................
Please complete the standing order form and return it to:
The Treasurer
Portland Village Association
82c Portland Place
London W1B 1NS