APPLICATION FORM
Please enrol me (spouse included) as a member of the “ANDERSON ASSOCIATION.”
Full name: ........................................................................................................ Title/Style: .........................
(capitals please)
Spouse/Partner’s name: .............................................................................. Title/Style: .........................
Address: .............................................................................................................................................................
........................................................................................................................ Zip/Postcode: .........................
Home Tel: ........................................ Bus Tel: ....................................... Date of Birth: ..........................
(omit year if you wish)
Mobile Tel: ................................................. E-mail: .....................................................................................
I attach payment of £12 (overseas memb: £15) for “The Andrean” & one year’s subscription.
Signed: ............................................................................................................ Date: .....................................
B A N K E R S S T A N D I N G O R D E R
To the Manager ........................................................................................................
.........................................................................................................................................
Please Pay to Barclays Bank PLC.,
Liverpool City Business Centre, Liverpool, Merseyside. (20 - 51 - 01)
For the credit of the “Anderson Association”
Account No. 80849626
Quoting reference ........................................... **
The sum of: £ 10.00 ( TEN POUNDS )
On the ................................................ Day of ........................................ 20 .....
And the like sum annually on the 30th day of NOVEMBER
In each subsequent year until further advised by me.
Signed ....................................................................... Date ..................... 20 .....
Name .......................................................................................................................
Account No .................................................................
NB : This mandate replaces any previous arrangement.
Please complete the above details of the Bankers Standing Order and send it to:-
Ian A. Anderson (Hon. Secretary/Treasurer)
Abbots Ann, Three Pears Road, Merrow, Guildford, Surrey. GU1 2XU
PLEASE DO NOT SEND THIS FORM DIRECTLY TO YOUR BANKERS