Hurst Village Society Membership Application/Renewal Form Please complete Section A, then either Section B or, if you wish to pay by Standing Order, Section C If you choose to pay by standing order, please don't let that stop you making a donation as well!  A  Name.......................................................... Address....................................................... Telephone No..................................................  B  I enclose my cheque/cash for £5.00, being my subscription for 2008. I also enclose a donation of £............... to the Hurst Village Society  C  To My Bank: Name...................................................Bank Address................................................ Sort Code........................................ Please debit my account, no .................................... with the sum of £5.00, being my subscription to the Hurst Village Society, and credit Account no. 01349706 (Hurst Village Society No 1 Account) at Lloyds TSB Bank plc, High Street, Bracknell, Berkshire RG12 1BT Sort Code 30-91-11 Date of first payment: immediately Date of second payment: 1st January 2009 And thereafter annually on 1st January Signature.............................................     Date...................

Payment can be made by printing this page and completing the Standing Order form or by cheque made payable to the Hurst Village Society.

Please give or send the completed form to:

The Membership Secretary Hurst Village Society Eddie Coe 4 Lodge Road Hurst RG10 0EH

or any other Committee Member.

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