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Are you an Old Aytonian?
Would you like to join the Old Scholars' Association?
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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.......
I /  We  (please delete as applicable) wish to become an annual Member(s)
of Ayton Old Scholars' Association (The annual subscription is £5 per annum - £2.00 extra per annum for partners)
UK£
I / We wish to pay our annual subscription by cheque - or - I / We wish to pay our annual subscription by Bankers Order (please delete as applicable)  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:
I /  We (delete as applicable) wish to become Life Member(s) of Ayton Old Scholars' Association (Life membership is £100.00 and £80.00 for partners)
I / We are over 50 years. (£50.00 for those joining at age 50 or over and £40.00 for partners, also aged over 50)
UK£

Please post this form with your cheque - if applicable -  to: AOSA Hon. Treasurer,
GEOFFREY MILLER, (2009-2013)
60, Elmway, 0191 Hilda Park, Chester le Street, Co. Durham DH2 2LX    
e-mail: Geoff.Miller@newdur.ac.uk

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