Membership Form
Name ________________________________________________
Address ______________________________________________
_____________________________________________________
Postcode _____________ Email _____________________
Phone _______________ Mobile ____________________
I / We wish to apply for the following membership of the Association.
Life member (£150)
Family member (£15)
Ordinary member (£10)
Student member (£ 5)
Signature of Applicant ___________________ Date _____________________
Email : himalnepal@hotmail.com website : www.nepaleseassociation.com
_________________________________________________________________________________
We would very much appreciate if you could fill in the Bank Direct Debit form attached as this will help us to avoid additional administrative work. Alternatively membership fee can be paid by cheque payable to Himalayan Yeti. Please write a cheque for Life membership.
Please return this form to the Treasurer: Dr Yogendra Bajracharya
100 Riverbrook Road
West Timperley
Altrincham
WA14 5UL
For Official Use Only
The Association would like to thank you for your support by becoming a member.
DIRECT DEBIT MANDATE
To: x_____________________________ Bank Plc, x_____________________ Branch
(Please fill in your Bank’s full name and branch)
Please Pay:
Beneficiary’s Bank and Branch Name – Barclays Bank, Didsbury Branch
Sorting Code Number
20-26-20
Beneficiary’s Account Number
60771856
Beneficiary’s Name
Himalayan Yeti
Nepalese Association in the UK
First Payment
£15.00
Date of First Payment
1st August 2010
Usual Payment
£15.00
Starting Date
1st April 2011
Frequency
1st April of Each Year
Account to be debited
x……………………….
Sort Code Number
x…………………….
Account Number
x……………………………………..
Signature(s) x________________________ Date x ________________________
Please fill all boxes marked (x) and return it to the Treasurer: Dr Yogendra Bajracharya
100 Riverbrook Road
West Timperley
Altricham
WA14 5UL