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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..........
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,Geoffrey Miller, 60 Elmway, Hilda Park, Chester le Street, DH2 2LX
Geoff.Miller@newdur.ac.uk

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