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Application for membershipType of membership (tick box)[ ] Individual £8 .. [ ] Double £14 .. [ ] Student Type of payment [ ] Cheque .. [ ] Banker's order Name (Mr/Mrs/Miss/Ms/other): Address: Telephone: BANKER'S ORDER Bank Account Number: Bank Name: Bank Address: Please pay Barclays Bank plc, Onslow Hall, Little Green, Richmond, Surrey for the account of the Richmond Local History Society, Account No. 2 (no. 50778869), bank sort code 20 72 17, the sum of £............. (amount in words ...........................................) on receipt of this order, and thereafter the same amount annually on the 1st January until further notice.Signed: Date: Please return this form with your payment, cheques payable to Richmond Local History Society, to: The Membership Secretary 10 Courtlands Avenue Hampton Middlesex TW12 3NT |