Membership

Application Form

You may pay by cheque or complete a Standing Order request.  For your convenience, please type in your details below online, print this form using the button provided and then return it to BCA at the following address.  The cost of membership is £20 per annum.   Please see the Introduction for details of Membership Rights and Liabilities.

Buckinghamshire Community Action
Unit B, The Firs
Aylesbury Road
Bierton
AYLESBURY, Bucks
HP22 5DX

Main Information

  
Contact Name
Group / Organisation
Position
Postal Address


Postcode
Telephone
Facsimile
e-Mail
Web Address


Payment Information (complete only the applicable section)

By Cheque

I would like to become a member of Buckinghamshire Community Action, and I enclose a cheque made payable to Buckinghamshire Community Action for £20 only.


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

Date .......... / .......... / ..........



By Standing Order
 
To (your bank)
Postal Address
(of your bank)


Postcode
I would like to make the following payment by standing order:
Please pay
The sum of
By credit to account number
At

Sort Code
Annually on the following date until further notice
Debit the account of
Account number
Signed in accordance with the Bank Mandate:


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


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

Date .......... / .......... / ..........

 

Office use only:

Date received Accounts Database