MEMBERSHIP FORM 2009

Subscription £10 – due 1^st January 2009

 

Name:        _____________________________________________

Address:    _____________________________________________

                   _____________________________________________

Email:        _____________________________________________

Telephone: ____________________  Mobile: _________________

I enclose a cheque for £10.00           I wish to pay by standing order

(payable to The Ruskin Society)

……………………………………………………………………………………………

Standing Order Mandate

To:                  ________________________________Bank (Name of your Bank)

Address:        _____________________________________________________

                        _____________________________________________________

Sort Code:      _________________   Account number: __________________

Please pay for the credit of The Ruskin Society, Account no: 0589207

Lloyds TSB Bank Plc, Potters Bar Branch (sort code: 30-16-64)

111 Darkes Lane, Potters Bar, Hertfordshire EN6 1BS, the sum of £ _______

now and on the first day of January annually thereafter until further notice.

 

Name:            _______________________________

Address:        _______________________________

                        _______________________________

Signature:      _______________________________          Date: ______________