mem_form

 

The Fareham Society — Membership Application/Renewal Form

 

Please print this page and complete the form (or write the details on a separate sheet of paper),

then send it with your payment as indicated below.

 

I/We wish to *apply for membership / *renew my/our subscription for 1st April 2017 – 31st March 2018 (for those still owing to The Fareham Society). * 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 £.........

 

Attached is cash/cheque payable to The Fareham Society to the amount of £...............

 

I/We agree with The Society's aims.

 

 

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

____________________________________________________________________________

 

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.

 

Standing Order mandate. Please complete the mandate below, detach it, and send it to your bank. Please note that payment for the current year (1st April 2016 - 31 March 2017) should be made by cash or cheque and sent or handed in to:

The Fareham Society, 12 High Street, Fareham PO16 7BL, or at a Monthly Meeting.

____________________________________________________________________________

 

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 2016 and thereafter annually on 31 May.

 

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

 

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

 

 

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