Standing Order Mandate Form

Please make TWO copies of this Standing Order Mandate Form. Complete both copies and return them to the Registrar with your application form.

Applicant's Details

Name of Account to be debited:
Account Number:
Bank Sort Code:	--
Name and Address of the bank:
Quoting Ref: Please insert your name here

Academy of St Cecilia Details
Name of Account to be credited:	Academy of St. Cecilia
Account Number:	91373331
Bank Sort Code:	40-07-30
Name and Address of the bank:	HSBC Bank, 5 Wimbledon Hill Road, London, SWI9 YNF
I have elected to pay my annual subscription of £20 (twenty pounds) to the Academy of St. Cecilia by Standing Order, the first payment to be made at once on receipt of this mandate, and annually thereafter on 1st November.
Signature :
Date:

Print TWO copies of this form and sign & date and enclose with your application form (Associate members and Fellows only)

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