AOSA Subscription Renewal
Your Name and Address |
|
| First name(s) | |
| Family Name | |
| Maiden Name | |
| Address - line 1 | |
| Address - line 2 | |
| Town / City |
|
| County / State | |
| Post / Zip Code | |
| Country | |
| Telephone Number | |
| E-mail address | |
| At Ayton - from / to | 19......... to 19.......... |
| Enclosed is my cheque for my AOSA annual subscription for the year 20............................... |
UK£........... |
| I / We wish to pay our annual subscription by Bankers Order | 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: |
|
Please post this form with your cheque - if applicable - to:
AOSA Hon. Treasurer,
Geoffrey Miller, 60 Elmway, Hilda Park,
Chester le Street, DH2 2LX
Geoff.Miller@newdur.ac.uk