The NOA 200 Club

Membership Application Form (Click for INSTRUCTIONS)

I would like to join the NOA 200 Club.

Name: ………………………………………………………………….

Address: …………………………………………………………………..

…………………………………………………………………..

Postcode: …………………………………………………………………..

Telephone Number: ………………………………………………………………….

E-mail Address: …………………………………………………………………..

(All future correspondence will be via e-mail where possible to reduce administration costs.)

How many shares @ £24 per year would you like to purchase? …………….

Payment

I enclose a cheque for £ ……. , payable to:

Norfolk Ornithologists' Association 200 Club

or:

I have completed the Standing Order form below

and forwarded it to my bank.

(Please tick as appropriate)

Please return this form to:

Ann Newman ,6 Nelson Drive, Hunstanton, PE36 5DU

================================================================================

Standing Order Form ( Please detach and send direct to your bank )

Please make the payments detailed below and debit my/our account.

Name of account to be debited: ……………………………………………………

Account number:........................(8 digits)

Sort code:.... -.... -....

Payments to be made to:

Barclays Bank Plc, Account Number: 70589993, Sort Code: 20-46-65

Reference number: .......................(Your Post code)

Please pay the sum of £.........(£6.00 per ticket) on 1 st January, 1 st April, 1 st July and 1 st October and on these dates annually thereafter to the credit of The Norfolk Ornithologists' Association 200 Club.

Signed: …………………………………….. Date: ………………………

Name: ……………………………………..