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GWENT BACH SOCIETY
PRESIDENT:  Dr. Roy Massey
FOUNDER:   Dr. Lloyd Davies
MUSICAL DIRECTOR:  Roger Langford


Associate Member's Subscription 2005 - 2006
Names

Address



Postcode


Telephone Number
(Including code)


Email

I enclose
a) A cheque for £17.50 payable to Gwent Bach Society
or

b) The completed standing order form below



STANDING ORDER MANDATE
To: Bank / Building Society

Address of Bank / Building Society:



  
Account Names:

Account Number:

Sort Code
................ / ................ / ................
  

Please pay Lloyds Bank Plc (30-90-02), Abergavenny, for the credit of Gwent Bach Society, Account Number 00018083, the sum of £17.50 (Seventeen Pounds and Fifty Pence only) on the 6th April 2004 and thereafter every 6th April annually until further notice.

This instruction cancels any previous order in favour of the beneficiary named above.

 

Signature
........................................................... Date..............................................

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