Subscription form

This form has been set up so that you can fill it in (apart from the signature) and then print it out.
(Currently we are unable to accept subscriptions by E-mail)

Send the Subscription form to LifeRites and the
Standing Order Mandate to your Bank (if required)

LifeRites
Gwndwn Mawr
Trelech
Carmarthenshire
SA33 6SA
UK

Send this part to LifeRites

Name Title

Address



County Postcode

I wish to subscribe to LifeRites and enclose the annual subscription of £16
(cheque no )

I wish to make a donation of £ to LifeRites
and enclose cheque no

I wish to subscribe to LifeRites and to pay by quarterly/half yearly/annual standing order
(Please complete the standing order mandate and forward it to your bank)

I wish to make a regular donation to LifeRites of £ ……..monthly/quarterly/half yearly/annually by standing order
(Please complete the standing order mandate below and forward it to your bank)

I agree to my details being held on a computer database and understand that it will be used solely for mailing and not disclosed elsewhere

Signed
Date / /

STANDING ORDER MANDATE

Please give this mandate to your bank and NOT to The LifeRites Group

To Bank

Address

Please credit The LifeRites Group
Barclays Bank PLC P.O. Box 75
FARNBOROUGH GU14 7YJ

Sort Code 20 61 82
Account no. 00265861

Sort Code - -

Account no

Account in the name of

Please debit my account with the sum of £ monthly / quarterly / half yearly / annually (Delete where appropriate)

Starting on / / until further notice

Signed
Date / /