MEMBERSHIP STANDING ORDER New or Renewal
By Louis M. Grabsky
Please print this form and complete Sections 'A' and 'B'
Return this form to:
The Treasurer, L M Grabsky, Flat 2 Lynton Court , 40 St. Aubyns, HOVE , BN3 2TD .
On behalf of the Executive Committee
Charlotte Gravestock, Secretary, IFCG
Section A
IFCG MEMBERSHIP FORM
HSBC Bank plc Standing Order Form
Please complete in BLOCK LETTERS Tick this box if joining ? or if renewing ?
Name:________________________________________________Telephone:_______________
Address:______________________________________________________________________
_____________________________ ___________ faith / tradition:________________
Post Code: _________ Email Address: _______________
I reside / work / worship / practise in the Brighton & Hove area. I agree with the aims of the IFCG and enclose annual subscription (From AGM to AGM).
I would also like to make a £______donation to IFCG Funds. (Separate Cheque to IFCG.)
Signed__________________________________ Date__________________
................................................................................................................................................
Section B
Please fill in the name of your bank and the branch your account is held at :-
Bank_______________________________Branch Sort Code _____/_____/_____
Name of account to be debited:-______________________
No. of account:- _________________
Please pay HSBC Bank plc Code 40- 25-06 Account Number 61229354
To the credit of: Brighton & Hove Interfaith Contact Group (IFCG), Ref. as Name of Account
Pay the sum of £10 immediately and the sum of £10 annually commencing 1st Feb. 2011
Signed :- _________________________ Date_________________
(Please alter 'of £10.........of £10' to; 'of £ 20....... of £ 20' and initial both places if for 2 Members.)
If wishing to pay by Cash or Cheque, please use 'Cash or Cheque' form.