Application for individual membership
Personal details
Please fill in this section completely. All the details are vital for our records.
Name: __________________________________
Address: _______________________________
E-mail: _________________________________
________________________________________
University or college: _____________________
________________________________________
Graduation or leaving date: _____________
Postcode: ______________________________
Optional Information
‘Phone Number: _________________________
Denomination: __________________________
Subject Area: ____________________________
You must have been a student within the last three years to become a member. If this
doesn’t apply, you can still become a Friend of SCM. Just ask for the appropriate form.
Membership details

I would like to apply for SCM membership £1

I would like to make an additional donation of £____

I enclose a cheque, payable to ‘Student Christian Movement’, for £____

I would like to pay by standing order:
standing order (easy payment scheme) instruction to your bank/building
society
To the manager of _____________________________________________ bank
address: ________________________________________________________________________________________
Please return to: SCM, 504F The Big Peg, 120 Vyse Street, Birmingham B18
6NE
_______________________________________________________ postcode: _______________________________
Account holder: ____________________________________________________________________
account number: ____________________________________ sort code: ______________________________
Please pay the sum of £…….. every year (minimum £1),
beginning on _____/_____/_____, to the Student Christian Movement
(account number 65357604, sort code 08-92-99), until further notice.
signed: ______________________________________________ date: ____________________________________
If you are a UK tax payer, you can allow us to reclaim income
and/or capital
gains tax on your donations.
Please treat all donations I make from the date of this declaration as
Gift Aid. Signed _______________________________ Date____________
Please return to: SCM, 504F The Big Peg, 120 Vyse Street, Birmingham B18
6NE