Application to join the 100 Club (part of Down Syndrome Extra 21)
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Please fill in and send to:- |
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Mr / Mrs / Miss / Ms
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Address
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Tel No
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| I apply to join the Down Syndrome Extra 21 100 Club. Should I wish to withdraw, I understand that I can do so by giving the organiser one month's notice. | |
Signed
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Date |
To (name / address of your bank) :
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Please pay Barclays Business Centre, 9, High Street, Colchester, Essex CO1 1DD (Sort Code 20 22 67) for the credit of the DSE21 100 Club, account number 50329606 the sum of £30, commencing (add date here) and thereafter every 6 months until further notice. |
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Reference (please enter your name here)
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Account to be debited
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Account Number
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Signed
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Date |