Falmouth Civic Society Enrolment Form

When complete please send to Mrs Felicity Nicholson, Fairhaven Cottage , Stratton Place, Falmouth TR11 2ST

Mr/Mrs/Miss/Ms

 

 

Surname

 

 

First names

 

 

Address

 

 

 

 

 

Post code

 

 

Telephone number

 

 

Family              |£7.50

Single |£5.00 (please tick)

Name of your bank

 

 

Address

 

 

Account number

 

Sort code

 

Please pay the sum of £     on the first day of March annually by standing order until further notice to the credit of the Falmouth Civic Society at Lloyds TSB Church Street, Falmouth

Sort code 77 09 13 account no 189682-68

Commencing from…………..

 

Signature