Members Sign up form
Email address *
Please complete this form to join the Members of Pitzhanger Manor & Gallery
To ensure that new Members receive a full years’ benefits from Pitzhanger’s opening date, all subscriptions for Members who join before March 2019 will run until March 2020.

Membership will be confirmed upon receipt of your payment (see details below).

Please get in touch with Emily Grassi, Members Officer, emily.grassi@pitzhanger.org.uk, should you have any questions about this form or the Membership Scheme.

Title *
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First Name & Surname *
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First Name & Surname (Please add the details of the second member for Joint Memberships)
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Home Address *
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Post Code *
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Mobile *
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Email (please confirm your preferred email for receiving our communications) *
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Email (please add the email of the second member for Joint Memberships)
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Your Membership (please tick as appropriate): *
Payment details
Please make your BACS transfer to:
Account name: Pitzhanger Manor & Gallery Trust
Sort code: 40-02-26
Account number: 82608928
Reference: Friend_Surname

Or send a cheque payable to Pitzhanger Manor & Gallery Trust
and post it to the attention of:
Emily Grassi, Members Officer
Pitzhanger Manor & Gallery
Mattock Lane, London W5 5EQ

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I understand that by submitting this sign up form I am giving my consent to receiving communications from Pitzhanger Manor and Gallery on news and opportunities related to the Membership Scheme and to the work of the Trust.
Your data will be stored securely. We will endeavour to keep your information accurate, up to date and secure at all times. We use MailChimp for emailing newsletters and communications. We will not share your data with any external agency, or other body.
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