Text Box: Irish Pointer Club Membership Application / Renewal Form Annual subscription falls due on 1st January . Single Fee: €14.00 Joint Fee: €17.00 I wish to apply for membership of the Irish Pointer Club I wish to renew membership of the Irish Pointer Club ( Delete as appropriate) Name ……………………………………… Return to: Mrs. S. Brophy (Hon. Sec) Address…………………………………….. Floodhall, ……………………………………………… Knocktopher, ……………………………………………… Co. Kilkenny. Tel………………………………………….. Please find enclosed subscription of €______ for year ________ Signed……………………………………… Text Box: STANDING ORDER MANDATE To: The Manager ……………………………………………………………………………………….. ( Name and postal address of your Bank) I/We hereby authorise and request you to debit my/our account. Account Name…………………………………………………. Account No Sort Code The sum of……….(amount in figures). …………………………………(amount in words) And to credit: Irish Pointer Club Account No Sort Code at : Bank of Ireland Westland Row, Dublin 2 Commencing: 1st January …………. And thereafter on 1st January annually until further notice in writing. It shall be understood that the Bank shall not be under any liability for damage or loss caused by an omission to make these payments. This instruction cancels any previous order in favour of the beneficiary named above, under this reference. Signature (s)……………………………………………. Date……………………... Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: Text Box: 1 Text Box: 0 Text Box: 3 Text Box: 5 Text Box: 7 Text Box: 7 Text Box: 2 Text Box: 4 Text Box: 9 Text Box: 0 Text Box: 1 Text Box: 3 Text Box: 7 Text Box: 8