APPLICATION FORM

Please enrol me as a member of the “CLAN ANDERSON.”

Full name:  ........................................................................................................  Title/Style:  .........................
(capitals please)
Spouse/Partner’s name:  ..............................................................................  Title/Style:  .........................

Address:  .............................................................................................................................................................

........................................................................................................................  Zip/Postcode:  .........................

Home Tel:  ........................................  Bus Tel:  .......................................  Date of Birth:  ..........................
                                                                                                                              (omit year if you wish)
Mobile Tel:  .................................................  E-mail:  .....................................................................................

I attach payment of £20 for “The Membership Certificate.” (optional)

Signed:  ............................................................................................................  Date:  .....................................
B A N K E R S    S T A N D I N G    O R D E R

To the Manager  ........................................................................................................

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

Please Pay to Bank of Scotland PLC.,
836, Crow Road, Glasgow. G13 1ET   (80 - 07 - 15)
For the credit of the “Clan Anderson”
Account No. 06002315

Quoting reference  ...........................................  **

The sum of:      £ 5.00     ( FIVE POUNDS )

On the  ................................................  Day of  ........................................  20 .....

And the like sum annually on the 30th day of NOVEMBER
In each subsequent year until further advised by me.

Signed  .......................................................................  Date  .....................  20 .....

Name  .......................................................................................................................

Account No  .................................................................

NB :  This mandate replaces any previous arrangement.
Name & full address of
Donor’s bank in capitals






**For office use

Annual amount to be paid

Date when payment starts



Signature of applicant

Mr/Mrs/Miss/Dr/Title
full name in capitals
Account No. To be debited
Please complete the above details of the Bankers Standing Order and send it to:-
Hon. Secretary/Treasurer
Info@clan-anderson.org.uk

PLEASE DO NOT SEND THIS FORM DIRECTLY TO YOUR BANKERS