The Anglo Norse Society - Membership application

THE ANGLO-NORSE SOCIETY
IN LONDON

Please print and complete this form and then send to the address below.

I/We would like to join the Anglo Norse Society and enclose the subscription

Annual rates.
Members under 25 or over 60	Ł 15	Family membership	Ł 25
Members aged 26 to 59	Ł 20	Corporate membership	Ł100

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode: . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone (home). . . . . . . . . . . . . . . . (work) . . . . . . . . . . . . . . . . .

Mobile: . . . . . . . . . . . . . . E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of birth (if under 26 or over 60) . . . . . . . . . . . . . .

2007 and future payments by standing order (form completed below)
2007 Payment by cheque for Ł . . . . . . . . Enclosed

Please return to The Anglo-Norse Society, 25 Belgrave Square, London SW1X 8QD

PAYMENT OF SUBSCRIPTION BY BANKERS ORDER
ANGLO-NORSE SOCIETY (Registered Charity No. 263933)

BANKER’S ORDER

To	__________________________________	Bank
Address	__________________________________	Sort Code	________________________
	__________________________________	Account Number	________________________
	__________________________________

Please pay to DnB NOR ASA, London Branch, 20 St. Dunstan’s Hill, London EC3R 8HY
(Branch sort code. 40-51-14)
for the credit of the Anglo-Norse Society (Account no. 62137001) the sum of Ł__________ with immediate effect and on the 1^st of January in every subsequent year until I give you further notice, debiting such payments to my account.
PLEASE CANCEL ALL PREVIOUS STANDING ORDERS/MANDATES IN FAVOUR OF THE ANGLO-NORSE SOCIETY

Signature(s). ______________________________________

Please print your name here: ______________________________________ Date: ______
Please send this form to The Anglo-Norse Society (NOT TO THE BANK) at
25 Belgrave Square, LONDON SW1X 8QD

If you pay tax in Britain please also complete and return the Gift Aid form.