| To (Name of bank) | |
| Sort code | |
| Branch address |
|
| Cutomer details: | |
| Account name | |
| Account Number | |
| Please set up the following standing order and debit my/our account accordingly: | |
| Organisation to pay | British Association of Educational Audiologists (BAEA) |
| Bank address | National Westminster Bank Worcester Cross 1, The Cross WORCESTER WR1 3PR |
| Account Number | 25101552 |
| Sort code | 55-81-36 |
| Amount of first and subsequent payments | |
| Date of payment (e.g. 1st May) | |
| Frequency | YEARLY |
| Commencing | |
| Until (expiry date) | |
Signed: Date: Please print and return to the membership secretary at the above address |