APPLICATION FOR MEMBERSHIP / RENEWAL OF MEMBERSHIP:

Friends of the Church of the Blessed Virgin Mary & St. Leodegarius

I enclose a BANKERS ORDER
Please pay to: Friends of Ashby St Ledgers Church Account 57232319301
at Hinckley and Rugby Building Society, Midland Bank Plc, 10 Market Place, Hinckley.

amount £

amount in words

start date

and annually on the same day,
until you receive further notice
from me/us in writing

to bank

banks address

banks post code

membership

join

renew

your title

your name

your address

your post code

signed

date

COMPLETE & PRINT out this form, sign and date it
then send to:
Miss D E Godden
194 Milton Street North
Northampton NN2 7DD

Thank you for your support

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