VALLEY CONSERVATION SOCIETY

Membership Application 2012 and/or Donation Form

                Doing nothing                

                is not an option

I/We should like to join/renew our membership with the Society                                        

Membership:  £2 each per year (50p aged 14 to 18) payable by cheque, cash or standing order (form below)

Name: (1) ……………………………………………..………. (2) ………….………….………………………………..

           (3) …………….………………………………..…..….. (4) …………..…………………………………………..

Address: ………………………………………………………………………………………Postcode …………………

Phone ………………………….. Mobile ……………………………….. Email …………………………………...……

I enclose cheque/cash for £ ………………………                         

OR I have completed the Standing Order Mandate                          (donations welcome)

Signature(s) …………………………………………………………………………………………………………………

 To help save costs, I am/we are happy to receive newsletters by email (please tick)   

Please send completed form/standing order mandate and cheque/cash (if appropriate) to:

Colin Holman, Membership Secretary,

Flat 3, The Manor, Hayle Place, Cripple Street, Maidstone, ME15 6DW

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Office use only:

S/O                      Issued                               Donation                        Membership Nos

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STANDING ORDER MANDATE

To the Manager

Your bank or building society name here:  ………………………………………………………………………………

Their address here: ………………………………………………………………………………………………………..

Please pay Lloyds TSB, 422 Loose Road, Maidstone, ME15 8PA

For the credit of Valley Conservation Society

Sort Code 30-95-37

Account Number 02166853

The sum of £  ……………………………

Commencing on the first day of January 20……..   and every year thereafter on the same date until further notice, and debit my account accordingly.

Your account name: …………………………………………………VCS Ref No: …………………………………..

Your bank’s sort code: …….……………………  Your account number ………………………...…………………

Signature: …………………………………………………………..  Date: ………………………………..................