Past Pupils Membership Form
Kilkenny College / Celbridge Past Pupils' Association
PLEASE PRINT OFF FORM BELOW FOR APPLICATION FOR MEMBERSHIP OR RENEWAL.
Kilkenny College / Celbridge Past Pupils’ Association
Application for Membership
Annual Subscription €15
Section A Personal Details:
Name: ___________________________________
Address: ___________________________________
___________________________________
E-Mail ____________________________________
Mobile ___________________________________
Years attended college: ___________________________
Section B - Subscription by Cheque
I will pay my annual subscription by cheque for €___________ enclosed. Please remind me when renewal is due.
Section C - Subscription by Standing Order
To: The Manager: Please cancel my existing standing order payable to Kilkenny College/Celbridge Past Pupils Association and replace it with the following new one:
Bank: __________________________________
Address: __________________________________
__________________________________
Please pay to Allied Irish Banks, 40 Westmoreland Street, Dublin 2.
N.S.C. (93-12-25) to A/C – Kilkenny College/Celbridge Past Pupils’ Association
A/C No. – 22714195 the sum of €15 from 1st May and each year thereafter until further notice and debit my account accordingly.
Signature: ___________________________ A/C No: ___________________
Name (in caps): __________________________________
Address (in caps): _________________________________
________________________________
NB: When completed please return this form to: |
Valerie Twomey, 7 Chesterfield Park, Castleknock, Dublin15. |