EAST SURREY MUSEUM MEMBERSHIP APPLICATION FORM TITLE (MR

APPENDIX E PHOTOGRAPH CONSENT FORM AGE UK SURREY FEELS
BIODIVERSITY & PLANNING IN SURREY MAY 2014 CONTENTS
CAMBERLEY HOUSE 1 PORTESBERY ROAD CAMBERLEY SURREY GU15 3SZ

CURRICULUM VITAE ELIZABETH SURREY PERSONAL INFORMATION ELIZABETH SURREY 8
EAST SURREY CCG GUILDFORD & WAVERLEY CCG NORTH WEST
EAST SURREY MUSEUM MEMBERSHIP APPLICATION FORM TITLE (MR

East Surrey Museum

East Surrey Museum


Membership Application Form


Title (Mr / Mrs / Dr, etc.) ___________


Full name ________________________________________________


Address _________________________________________________


_________________________________________________________


_________________________________ Postcode _______________


Email __________________________


Telephone _____________________


I wish to become a Friend of East Surrey Museum


Signature _______________________________________


Date _____________


Please note that by providing your contact details and signing this application form you agree to the use of your details by East Surrey Museum solely to provide the benefits of membership. Data will be held on a computer but will never be divulged to a third party. Your bank details will not be held on the computer.


Please return this form, together with cash or cheque payable to ‘East Surrey Museum’ to The Curator, East Surrey Museum, 1 Stafford Road, Caterham, Surrey CR3 6JG. The current annual subscription is £10.

Alternatively, to pay by standing order, please proceed to the standing order page opposite.

Standing Order Application


To the Manager (please insert the name of your bank or building

society):

_______________________________________________________


Address (of bank, including postcode) ________________________


________________________________________________________


________________________________________________________


Your bank’s sort code ______________________


Your account number ______________________


Please pay, on 1st April next, and then each subsequent year on the same date, the sum of TEN POUNDS from the above account to the credit of EAST SURREY MUSEUM:


Bank ___________________________________________________


Sort code ___________________________


Account number _____________________


(For security reasons the above details of the museum’s account will be inserted by the museum’s accountant).


Your full name ____________________________________________


Signature & date __________________________________________


Please return the whole of this form to the museum, not to your bank.



GEORGE ABBOT SCHOOL WOODRUFF AVENUE BURPHAM GUILDFORD SURREY GU1
MIND IN CROYDON 26 PAMPISFORD ROAD PURLEY SURREY CR8
N ORTH EAST SURREY CREMATORIUM BOARD LOWER MORDEN


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