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Please print this form, complete it, and return it to the Membership secretary


To: (name of bank) . . . . . . . . . . . . . . . . . .

Branch: . . . . . . . . . . . . . . . . . . . . . .

Bank Address . . . . . . . . . . . . . . . . .

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

Please Pay:

*1. The sum of £                immediately on receipt of this document and then
* (DELETE 1 IF IT DOES NOT APPLY, FOR EXAMPLE IF YOU HAVE PAID YOUR INITIAL SUBSCRIPTION BY CASH OR CHEQUE)

2. The sum of £            annually, starting on the First of January 20…

To: [details will be inserted by the Society]


 
 

Your Account Name:

Your Bank Details: Sort code: □□-□□-□□    Account No: □□□□□□□□

Signature:

Date:

This order supersedes any other Banker’s Orders in favour of the Dvorak Society and is to remain in force until further notice in writing.

PLEASE SEND THE COMPLETED FORM TO THE MEMBERSHIP SECRETARY OF THE DVORÁK SOCIETY AND NOT TO YOUR BANK


The Dvořák Society web pages are edited by Dvorak Society member Ray Latham
Last modified 6th January 2005