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Old Masonians Association

Andrew Foster
Registrar
Cadogan, 45 Hartford Road, Darlington,
Durham,DL3 8HF, United Kingdom
E-mail: andrew.foster5@icloud.com

Please enrol me as a member of the Old Masonians Association.  
I enclose a cheque for £20 now and a Bankers Standing Order to cover my future annual subscription (see form below).

Surname (Block Capitals)........................................

 

Christian Names.........................................Date of Birth.......................

Address.....................................................................................

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

Town.............................County...........................Post Code.................

Country........................................

Telephone: ...................................

E-Mail: ..................................................................

Year of leaving Bushey.......................House........................

Profession ...............................................................

I would be interested to assist in the administration of the Association......Yes/No

DATA PROTECTION ACT 1998
I, the undersigned, hereby consent to the processing of personal data and information supplied on this Form and
in consequence of my membership, to its use by the Old Masonians Association.

Signed.................................................Date.....................


TO:


My Bank....................................................

Branch ........................................

Sort Code.................     Account number.........................................

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

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

Please pay the sum of £20 on the 1st May annually

Commencing (date)................................

To:  Santander Bank
Sort Code:   09 01 55
Account Name: The Old Masonians Ass Subscription Account
Account No:   38816708

and debit my account with this sum.
 

Signed..................................................................

Name (Block Capitals) ..................................................

Address .................................................................................

 

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

Date .......................................
 

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