YOUR NAME AND ADDRESS |
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| First name(s) | |||
| Family Name | |||
| Maiden Name | |||
| Address - line 1 | |||
| Address - line 2 | |||
| Town / City |
|
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| County / State | Post / Zip Code | ||
| Country | |||
| Telephone Number | E-mail address | ||
| At Ayton - from/to | 19....... to 19....... | ||
| I
/ We (please delete as applicable) wish to become
an annual Member(s) of Ayton Old Scholars' Association (The annual subscription is £5 per annum - £2.00 extra per annum for partners) |
UK£_______ |
| I / We wish to pay our annual subscription by cheque - or - I / We wish to pay our annual subscription by Bankers Order (please delete as applicable) | UK£_______ |
| Bankers Order: To the Manager................................................... Bank Ltd | |
| Bank Address: | |
| Please
pay to HSBC Bank, Middlesbrough (40-33-01) for the credit
of Ayton Old Scholars Association, Account No. 50116351 the
sum of £................................... (words.............................................................) on 1st April 20..... and annually on the same day until this order is revoked by me, debiting my / our Account No....................................... |
|
| Signed: |
|
| I
/ We (delete as applicable) wish to become Life Member(s)
of Ayton Old Scholars' Association (Life membership is £100.00
and £80.00 for partners) I / We are over 50 years. (£50.00 for those joining at age 50 or over and £40.00 for partners, also aged over 50) |
UK£________ |
Please post this form with your cheque - if applicable - to:
AOSA Hon. Treasurer,
GEOFFREY MILLER,
60, Elmway,
Hilda Park,
Chester le Street,
Co. Durham DH2 2LX