MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION
(Please print and post to the Membership Secretary)
To:Stewart Edge,
28, Beavers Road, Farnham Surrey GU9 7BD
01252 716372
 
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 £__________(Alternatively complete the Bank Mandate below)
——————————————————————————–
STANDING ORDER MANDATE
Please pay on the first day of October each year the sum of £10 (Ten 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 60-11-08
Name and Address of YOUR Bank:  Account in name of:
____________________________
To: The Manager______________________ Bank PLC
Bank Account Number:________________________
Signature ____________________________Date_____________________

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