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Membership Form
EAST ANGLIA BORDER TERRIER CLUB
APPLICATION FOR MEMBERSHIP
I/we wish to apply for membership of the East Anglia Border Terrier Club
Name __________________________________________________
Address _______________________________________________________________
______________________________________________________________________
____________________________________________ Postcode __________________
Telephone number __________________________
Proposed by ______________________________ (Signature) ___________________
Seconded by ______________________________ (Signature) ___________________
Membership subscriptions are £6 single and £7 joint per year.
Please send the completed top half of this form to Mike Hollingsbee, 18 Lancaster Close, Stevenage, Herts SG1 4RX
Please enclose cheque made out to EABTC for the first year then complete and send attached standing order form to your own bank
To _____________________________________ Bank (STANDING ORDER MANDATE)
Postal Address _______________________________________________________
Please pay Lloyds TSB Bank, Risbygate Branch, 28 Risbygate,
Bury St Edmunds, Suffolk IP33 3AH (Sort Code 30-91-49)
For the credit of East Anglia Border Terrier Club (Account Number 1386390)
The sum of £____ Amount in words ______________________________________
Commencing 1st January 200__ and then annually until further notice in writing
Debit account ___________________________ Account Number ______________
Surname ___________________________________________
First and other names _________________________________
Title _________ Signature(s) __________________________________________