North Cheshire
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Join The North Cheshire
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Type Of Membership (please tick) |
Individual £3.00 Family £5.00 |
|
| First Name. | ||
| Last Name. | ||
| Address. | ||
| Post Code. | ||
| Telephone No. | ||
| Mobile Phone. | ||
| E-mail address. | ||
|
|
||
| To (Bank) : | ||
| Address (Bank) : | ||
| Please Pay : Barclays Bank PLC, Holmes Chapel, Sort Code : 20-53-77 Account Number : 50707686 |
||
| 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 |
||
| Account to be debited name : | ||
| Account to be debited sort code : | ||
| Account to be debited number : | ||
| Signature(s) : | ||
| Date : | ||
The Membership Officer, |
||
| Top of page | Back | Home |