Birmingham FOE - Standing Order Form

	The Membership Secretary Birmingham Friends of the Earth 54 ~ 57 Allison Street Digbeth Birmingham B5 5TH

Membership Standing Order Form I/we wish to make a monthly subscription to Birmingham Friends of the Earth of: £2.00 .... £3.00 .... £5.00 .... £8.00 .... £10.00 .... £20.00 .... Other .......... please state.
Individual Details	Joint Details
Title .......... Forename ................................. Surname ..................................................... Address ...................................................... Area ........................................................... City ................................ Postcode ............	Title .......... Forename ................................. Surname ..................................................... Address ...................................................... Area ........................................................... City ................................ Postcode ............
Membership Type Required Individual .... Family .... Joint .... Newsletter Required Yes / No
Bank Details
Bank .......................................................... Address ..................................................... Area .......................................................... City ................................ Postcode ...........	Account No ............................................... Sort Code .................................................. Acc Name ..................................................
Please pay the sum of £ .............Monthly starting on the .................................. to: Friends of the Earth Birmingham Account No. 50 72 58 30 Sort Code: 08-60-01 Unity Trust Bank Nine Brindley Palce 4 Oozells Square Birmingham B1 2HB Signature ............................................... Date ........................