Old Masonians Association

George J HART
Registrar
8 Redland Court Road
Redland, Bristol.  BS6 7EQ
Telephone:  0117 9249151
E-mail: hartshearth@aol.com

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

Surname (Block Capitals)……………………………………………………………………

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

Address………………………………………………………………………………….…….

………………………………………………………………………………………………….

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

Telephone: ………………………

E-Mail: ……………………………………………………………………

Year of leaving Bushey……………………House………………………………………

Profession………………………………………………………………………………….


I would be interested to assist in the administration of the Association…......YES / NO

I consent to my address details being displayed on the members only section of the OMA web site  >  YES / NO  (Please indicate YES or NO - if not we will assume you do not wish your address details displayed.)

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  ……………………………………

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 ………………………