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Please return this completed form to the school office in an envelope marked FOSPA 100 Club FOSPA 100 CLUB MEMBERSHIP FORM I wish to become a member of the FOSPA 100 Club. I agree to pay a subscription by either: (Please tick the relevant box) Bank Standing Order for £12 per annum. If using this option, please fill out the standing order mandate below and forward it direct to your Bank or set up your payment online. or Cash or Cheque for £12 to be paid annually Cheque payable to FOSPA 100 Club Signed _____________________________ Date __________________ Name (in block capitals) _____________________________________ Address _____________________________________ _____________________________________ Telephone Number _____________________________________ Name and Class of child if at St Paul’s _____________________________ STANDING ORDER MANDATE Please fill in your bank details below: To: __________________________________ Your Bank Name __________________________________ Branch __________________________________ Bank Address __________________________________ Please pay Barclays Bank plc, Dorking Branch, The Gatwick Group, Sort Code 20-23-97 for the credit of FOSPA 100 Club, Account Number 10342726 the sum of £12 commencing on _____________ and thereafter annually until further notice. Account to be debited: Name _______________________ Account Number ___________________________ Sort Code_____________________ Signed____________________________Date _________