MEMBERSHIP APPLICATION

I wish to join / renew my membership and enclose £5.00 (£8.00 European, £12 ROW) for one year starting 1st January.

NAME................................................................................................
ADDRESS.......................................................................................... ...............................................................Post Code............................
Free Advert........................................................................................
..........................................................................................................
Please send to the Treasurer, Mike Shrimpton, 59 Fouracre Road, Downend, BRISTOL, BS16 6PH.

To save yourself the trouble of posting a cheque every year, why not fill in a Standing Order. Simply fill in the form below and send it or hand it in to YOUR Bank.

WEST AND MIDLANDS PHILLUMENISTS

STANDING ORDER FORM

To the Manager.................................................................................................Bank Plc.
..............................................................................................................................................

Please pay to the NatWest, Downend Branch, PO Box 233, 18 Badminton Road, Downend, BRISTOL, BS99 5AU, - Branch Code 52 – 10 – 48, for the account of The West & Midlands Phillumenists, Account No. 04927869, one of the following:

a) One payment of £5.00 now and on the 2nd of January each year until further notice.
b) One payment of £5.00 on the 2nd January each year until further notice.

Please delete that which is not applicable.

Name: Signature:
Address:

 

Date:
Bank Account No.

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