LUDLOW21 Membership Application Date

Part A (please complete and return to Membership Secretary)

I/We apply for membership of LUDLOW 21 – a Company Limited by Guarantee, registered in England and Wales (Reg. No. 5903170). I/we shall remain a member/s until the Membership Secretary has received my/our resignation by email to or letter.

I/We undertake, if the Company is dissolved while I am/we are a member or within 12 months thereafter, to pay £1.00 towards the cost of dissolution and the liabilities of the Company while my/our membership lasts.

The annual subscription is £10 per person / £12 per household

Name/s Tel No

Address

Email: Signature

I/we wish to pay by (please tick as appropriate):

Standing order – preferred method of payment that keeps our admin to a minimum.

Please complete and detach form below and take/send to your bank and write

payment date in box.

Cheque Please make payable to “LUDLOW21” and return Part A together with payment to: Clare Currant, Steventon House, Steventon, Ludlow SY8 4BN

BACS through your internet banking. Details of Ludlow 21 bank account are:

Natwest Bank; Sort code: 53 81 18

Account Number: 82529450

Account Name: LUDLOW21

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

Please register me as a supporter (Fill in your details above, and send to Clare Currant, Steventon House, Steventon, Ludlow, SY8 4BN

Please remove my name from the contact list. (Fill in your details above.)

……………………………………………………………………………………………………………………………………………………………

Part B Standing Order instruction for your bank

Please instruct your bank on internet or phone, or by letter using this form, (Part B only):

Name of Your Bank:

Sort Code:

Your Account Number:

Please pay£10/£12 annually on:

To:

Natwest Bank; Sort code: 53 81 18

Account Number: 82529450

Account Name: LUDLOW21; Reference: L21 Subs/your surname

Name Signature Date

(Please DO NOT SEND this SO form [Part B] with your bank details to the membership secretary)