AOSA Membership Renewal print out page

Your Name and Address
First name(s)
Family Name
Maiden Name
Address - line 1
Address - line 2
Town / City
County / State
Post / Zip Code
Country
Telephone Number
E-mail address
At Ayton - from / to	19......... to 19..........

Enclosed is my cheque for my AOSA annual subscription for the year 20...............................	UK£.............
I / We wish to pay our annual subscription by Bankers Order	UK£...........
Bankers Order: To the Manager................................................................ Bank Ltd
Bank Address:............................................................................................... ..............................................................................................................................
Please pay to HSBC Bank, Middlesbrough (40-33-01) for the credit of Ayton Old Scholars Association, Account No. 50116351 the sum of £................................... (words.............................................................) on 1st April 20..... and annually on the same day until this order is revoked by me, debiting my / our Account No.......................................
Signed:

Please post this form with your cheque - if applicable - to: AOSA Hon. Treasurer,
William Pine, 20 Meadowfield, Stokesley, North Yorkshire TS9 5EY
Tel: 01642 711 505
e-mail: william_pine@lineone.net