MEMBERSHIP RENEWAL FORM

MEMBERSHIP RENEWAL FORM
PLEASE USE BLOCK LETTERS THROUGHOUT
Mr/Mrs/Miss/Ms
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
Date
Tel
Format: (000) 000-0000.
Email
example@example.com
Affix
Please indicate your interest by underlining what you would like to receive information on:

SHOWINGWORKINGRESCUE
Subscription: £10 Single (£10.50 if paying by cheque)
£12 Joint (£12.50 if paying by cheque) (Husband and Wife or two members of a family or partnership)
£15 Overseas
On completion, please return this part to the Membership Secretary: Alison Manton, 26 Pollards Green,
Chelmsford, Essex CM2 6UH Tel: 01245 460029 E: alllisonmanton@hotmail.com
Members may only pay by Bankers Order/Cheque/Postal Order. Bankers Order is preferable.
Memberships not renewed by 30^th April each year will need to re-apply. If paying by Bankers Order, please complete the form below and sent the top of half of this form to the Membership Sec and send the Bankers Order direct to your bank.
I wish to pay by Bankers Order and have forwarded it to my bank (Please tick if applicable)
Please pay to HSBC Plc, 47 High St, Sheringham, Norfolk NR26 8DS, Sort Code 40-41-38 the sum of
£10/£12 on 1^st January and, thereafter, the same sum to be paid on 1^st January
ANNUALLY. To be credited to Account No: 21050249 of Eastern Counties Golden Retriever Club.
For overseas subscriptions, our IBAN no is: GB13HBUK40413821050249 and the BRANCH IDENTIFIER
CODE: HBUKGB4154K
This order cancels any previous order in favour of Eastern Counties Golden Retriever Club
Should be Empty: