| Please print out the form, fill-out and return to: The Membership Team, The Vegetarian Society, Parkdale, Dunham Road, Altrincham, WA14 4QG or Fax: 0161 926 9182 (do not fax Direct Debit forms) |
| Name
(Ms/Mrs/Miss/Mr)
Address
Postcode Telephone No. e-mail Address: Date of Birth: I am a vegetarian Yes[ ] No[ ] THREE WAYS TO PAY - 1. DIRECT DEBIT (see below - not by fax) 2. I enclose a Cheque/PO £_______________ 3. Please charge my Mastercard/Visa/Amex/Switch Issue No. (Switch only)
Name on Card Signature Please tick if you do not wish
to receive information about: |
Adult Membership Junior Membership Family Membership
Life Membership Overseas membership I would like to
make a donation to help the Society's valuable campaign work Gift Aid |
|
Instruction to your
Bank/Building Society to pay by Direct Debit |
||
Name
& full postal address of your Bank or Building Society
Name(s) of Account Holder(s):
|
Originator's Id No:[7][2][4][3][6][6]Reference Number (for office use only)
Instructions to your Bank/Building Society Please pay The Vegetarian Society Direct Debits from the account detailed
in this instruction, subject to the safeguards assured by the Direct
Debit Guarantee. Signature(s): Date: Banks and Building Societies may not accept Direct Debit Instructions for some types of account |
|
This guarantee should be detached and retained by the Payer
The Direct Debit Guarantee
|
Many thanks for your support