Friends of the Dymock Poets

Application for Membership

 
To join the Friends of the Dymock poets, please print out this form, complete it, and send it to the FDP's Membership Secretary, whose address is given below.

Full Name/names:

 

 

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Address:

 

 
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Post Code:

 

 

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Evening Tel no:

 

 

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E-mail Address:

 

 

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Subscription Rates

 

UK

Tick

 

Europe

Tick

 

North America & Asia

Tick

Individuals

£7

[ ]

 

€14 (£10)

[ ]

 

$25 ($C39; £15)

[ ]

Couples/Families/Societies

£12

[ ]

 

€21 (£15)

[ ]

 

$30 ($C47; £18)

[ ]

Students

£3

[ ]

 

€7 (£5)

[ ]

 

$20 ($C31; £12)

[ ]

 
Additional Contributions are always gratefully received  [ ]
 

Either:

1. I enclose a cheque for £.................. to cover one year's membership of The Friends of the Dymock Poets plus a contribution (if applicable).
or
2. I would like to pay my subscription to The Friends of the Dymock Poets by standing order and have filled in the Standing Order Mandate below.

Please send the completed form with your payment to the FDP's Membership Secretary.
Cheques can be in UK Pounds or US Dollars.

Jeff Cooper, 122 Preston New Road, Blackburn, Lancashire, BB2 6BU.
Tel: 01254 662923 - Fax: 01254 610979
Email for enquiries: membership@dymockpoets.co.uk

 
 
 

Friends of the Dymock Poets

Standing Order Mandate

 
Name, address and sort code of your bank or building society (please print):

To:

 

 

 

 

Sort Code


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............  -  ............  -  ............

 
Please pay to HSBC, Malvern, Worcs (sort code 40-31-09) for the credit of the FRIENDS OF THE DYMOCK POETS (account no 61356461)

the sum of £.................. commencing immediately, and thereafter on 31st October each year until further notice in writing.

Office Use: Bank - Please quote our reference:


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Name of account to be debited:


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Account number:


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Signature:


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Date:


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Please print your Name/names:

  

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and Address:

 
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Post Code:

  

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Please send the completed mandate to
Jeff Cooper, 122 Preston New Road, Blackburn, Lancashire, BB2 6BU.
 

 

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