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

Email address:

 

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

Sort code

Commencing from…………..

 

Signature

 

 

In view of the potential for on-line fraud we have removed details of the Society's bank account from this form.  By signing the membership application form and bank mandate you agree to the Society adding the details of the account on receipt of your application.