North Cheshire
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Join The North Cheshire
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Type Of Membership (please tick) |
Individual £3.00 Family £5.00 |
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First Name. | ||
Last Name. | ||
Address. | ||
Post Code. | ||
Telephone No. | ||
Mobile Phone. | ||
E-mail address. | ||
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To (Bank) : | ||
Address (Bank) : | ||
Please Pay : Barclays Bank PLC, Holmes Chapel, Sort Code : 20-53-77 Account Number : 50707686 |
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Amount : £ | ||
Amount : (words) | ||
Date of first payment : | ||
Due date thereafter : 1st June annually *Until notice in writing / Until the date (* delete as applicable) Please cancel all other standing orders or direct debits in favour of the above beneficiary |
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Account to be debited name : | ||
Account to be debited sort code : | ||
Account to be debited number : | ||
Signature(s) : | ||
Date : | ||
The Membership Officer, |
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