MEMBERSHIP APPLICATION
(Please print and post to the Membership Secretary)
To: David Chun, Membership Secretary, The William Cobbett Society,
1, Meadow View Cottages, Spring Grove, Burlesdon, SO31 8BB, Hampshire.
I/We wish to join The William Cobbett Society
NAME(S): capitals please________________________________________________
ADDRESS:____________________________________________________________
_____________________________________________________________
TELEPHONE NO:_________________________
Email:_________________________________
DATE:________________________
I/We enclose my/our cheque for £__________OR Complete the Standing Order (suggested) below
$-
STANDING ORDER MANDATE
Please pay on the first day of October each year the sum of £8 (Eight Pounds) commencing on 1st October 20___ (year) until further notice, quoting
Reference ___ (to be inserted by the William Cobbett Society).
Payments to be made to "The William Cobbett Society"
Account No. 59454466 at National Westminster Bank 60-
Name and Address of YOUR Bank: Account in name of:
____________________________
To: The Manager______________________ Bank PLC
Bank Account Number:________________________
Signature ____________________________Date_____________________