Application Form

The Betchworth & Buckland Society

For the protection and conservation of the quality of life in

Betchworth and Buckland

 

Application / Renewal Form

 

YOUR NAME(S) …………………………………………………………………

I/We wish to become a Member of the Betchworth & Buckland Society and set up a standing order.

I instruct my Bank to set up a standing order to Betchworth & Buckland Society for £10 per annum, starting   .…./..…/2016 and continuing until otherwise instructed.

YOUR BANK DETAILS:

Bank Name…………………………………………………………………………

Bank Address………………………………………………………………………

Account Number……………………………. Sort Code……………………

Name(s) of Account Holder………………………………………………….

Please credit the Betchworth & Buckland Society bank account, with reference ‘new member’:

Barclays Bank PLC., Reigate Branch, Account No. 00166499, Sort Code 20-23-97

Signature……………………………………………………………………………

Your Address………………………………………………………………………

………………………………………………………………………………………….

………………………………………….Post Code………………………………

Email……………………………………………………………………………….

 

Please return this form to:

Mrs Charmian Stow, Membership Secretary

East Sandhills, Sandy Lane

Betchworth RH3 7AA

Email: betchworthandbucklandsociety@gmail.com

Alternatively you may pay by cheque, payable to ‘The Betchworth & Buckland Society’