Standing Order Form: Friends of Burns National Heritage Park (UK residents only)

If you would like to pay by Standing order:

Step 1: Complete the form Below
Step 2: Print out the form, sign it and send to your bank
Step 3: Send the form using the 'Send Form' button

Your Details
Title:
First Name:
Surname:
Address:
Type of membership:	Individual         £15.00 per annum Concession      £8.00 per annum Family              £30.00 per annum Club/Company £50.00 per annum Life                   £100.00 Founder           £250.00 minimum donation
Your Bank Details
To the Manager: (your bank)
Branch Sort Code:
Address:
I hereby instruct you to pay the sum of on or immediately after the 1st day of (enter the month you would like your membership to begin) every year
Commencing:
From my Account No:
In the name of:
Into the following Account:
Bank of Scotland 123 High Street Ayr KA7 1PQ	Sort Code 80-12-39 Burns National Heritage Park A/C No 00139564
Signed:
Date: