SAS Membership - Direct Debit Form

Enter the relevant details in the boxes provided

Your Details:

Name:
Address:
Postcode:
Telephone:
Email:
Membership Number (if renewing):

Your bank and account details:

Name of Bank/Building:
Bank/Building Society Address:
Bank/Building Society Postcode:
Name of Account Holder:
Branch Sort Code:
Account Number:

I would like to pay my Membership Subscription as indicated below:

	Unwaged	Single	Family	European	International
Annually:	£12.00	£18.00	£24.00	£21.00	£24.00
Monthly:	£1.00	£1.50	£2.00	£1.75	£2.00
Other monthly:	£3.00	£5.00	£10.00