mem_form

 

The Fareham Society — Membership Application/Renewal Form

Please print this page and complete the form and send it with your payment as indicated below.

I/We wish to *apply for membership / *renew my/our subscription for 1st April 2018 – 31st March 2019

* Please delete if not applicable.

Mr/Mrs/Miss/Ms ....... Initial(s) .......... Surname ......................................

Address ...........................................................................................

.................................................................................................... Postcode .............................

Telephone no. .................................... E-mail ......................................

Tick membership type:

[ ] Adult £ 4.00, [ ] Adult couple £ 5.00, [ ] Senior £ 3.00, [ ] Senior couple £ 4.00

These are the minimum annual subscriptions and any extra donation would be welcome.

Donation £.........

I/We wish to pay our annual subscription by [ ] standing order, [ ] cash, [ ] cheque. Tick as appropriate.

If you wish to pay by standing order please complete the mandate below, detach it, and send it to your bank.

Otherwise please attach a cash/cheque payable to The Fareham Society to the amount of £............... and send to:

Membership Secretary, The Fareham Society, 12 High Street, FAREHAM PO16 7BL

or hand to the Membership Secretary in an envelope with your name and address at the next monthly meeting. Please include a stamped addressed envelope if you require a receipt.

I/We agree with The Society's aims. I/We also agree to the personal data above to be stored. Note this data will never be given to a third party

Signed .........................................................

____________________________________________________________________________

Standing Order Mandate

To (YOUR BANK) ............................................. Bank plc

Address .............................................................................................................................

Please pay to Lloyds Bank plc, Fareham (sort code: 30-93-17)

for the credit of The Fareham Society (account number: 0117 8319)

the sum of £ ............ (amount in words) ..............................................

to take effect from 31 May 2018 and thereafter annually on 31 May

Account to be debited .......................................

Account number ...................... Sort code ............

Signature ..................................... Date .........................