The Stratford-upon-Avon Canal Society - Application for Membership

To print this page, right click on this web page and select 'print' from the drop down menu that appears, please
complete all sections and send the top part to the Membership Secretary and the bottom part to your bank.

To: Clive Henderson - Membership Secretary, The Stratford-upon-Avon Canal Society, The Bridge House,
Church Lane, Lapworth, Solihull, B94 5NU. I/We wish to join The Stratford-upon-Avon Canal Society.

Name(s) ...................................................................................................................................................

Address ...................................................................................................................................................

.................................................................................................... Post Code ...........................................

Telephone ................................... email ....................................................................................................

I/We wish to pay future subscriptions by Bankers Order and have completed (and signed) the Standing Order form and sent

it to...........................................................................................................................................................

Signed: .......................................................................... Date: ................................................................

Subscription Rates (tick which applies)
_____Annual Membership £10.00 (Individual or Joint) payable by bank standing order.
_____Life Membership Individual or Joint £120.00 by one-off payment by cheque sent to the above.

Please complete the standing order form below and send it to your bank or alternatively you may be able to set up
your standing order using your online banking facility, then forward the top of this form to the Membership Secretary
at the address shown above to confirm S/O arranged.
------------------------C U T ------------------------H E R E ------------------------------------------------
Bank Standing Order

Your Bank’s name: …………................................……………… Bank sort code …… - …… -……
Bank full address : …………………………………………………………………….…………………….

Please Pay Alliance and Leicester Commercial Bank plc Bootle 72-00-01
For the credit of The Stratford-upon-Avon Canal Society Account 80998307

Quoting Reference:(your surname & initials) ………………………………………..

The Sum of £10.00 (………………..pounds) commencing 1st September 2008 and thereafter annually on 1st September
until further notice in writing and debit my/our account accordingly.

Name of account to be debited: …………………………………….............…………………

Account No: ………………….

Signature………………………..................................…………Date…............………………
Feb 2008