The Guernsey Society

Membership Application Form

Name   Title Mr/ Mrs/ Miss/ other
Address  
   
Town/City  
County   Postcode  
Country  
Telephone   Email  
Banker's Order
To Bank Sort Code  
Address  
    Postcode  

Immediately and on receipt of this order and on the first of April in each year thereafter, until further notice is given from *me/us in writing, please pay Girobank, Bridle Road, Bootle, Merseyside GIR OAA, Sort code 72-00-04, to the credit of the Guernsey Society a/c number 06704287, the sum of *£8.00/**£10.00 and debit *my/our account with you for the same accordingly.

This order cancels all previous instructions in favour of the Guernsey Society.

* Delete where not applicable

** For shared membership such as husband and wife, Societies, Libraries, Museums and other Groups.
Signature    
Name
(Block Capitals)		   Account Number  
Please print out, complete and send to
Mrs Sylvia Cartwright, 9 Merlands, De Burgh Park, Banstead, SURREY SM7 2PP
together with Subscription fee or completed Bankers Order.