DONIZETTI SOCIETY

Membership Subscription Renewal for addresses outside the UK
beginning April ______ .

Your membership renewal is now due. It is a help to the Society if you renew promptly. Please print off and send this form to the Donizetti Society Secretary: Mr. Pip Clayton, 146 Bordesley Road, Morden, Surrey SM4 5LT, UK, telephone +44 20 8648 9364.

Title and Name

  

 

Address

(if changed)

  

  

  

I would like an annual membership (23 GBP) _____ / three year membership (65 GBP) _____ . (Please tick as required).

If you wish to pay by credit card then please include below your credit card number, expiry date and security number (if your card has one). Our card clearer now requires the security number if there is one.  The information is destroyed once the payment has gone through.

Cheques in sterling should be made out to "Donizetti Society".

If you wish to pay by interbank transfer, then IBAN is GB55 BARC 2097 0160 5191 46  and SWIFT is  BARCGB 22

 Card type,

 delete as applicable

                  Visa                                   Mastercard     

  Card no.                                                                                         Expiry date                  

 

 Security number    ......................

(usually the last 3 numbers on the signature block on the  back of the card.  Please note it is NOT your pin number)

Thank you