Only to be completed if you are paying by card - please print, complete, and mail to
Graham Stapleton, BSS Treasurer, 50 Woodberry Avenue, London HA2 6AX, UK)
_________________________________________________________________________________________
Please debit my MasterCard / Visa / Switch / Delta / Electron / JCB / Maestro / Fortoak
With the sum of £…………..
Card Number _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
Valid from _ _ / _ _ Expiry date _ _ / _ _ Issue number (Switch) _ _
Security code (last 3 digits on signature strip on reverse of card) _ _ _
Your name as it appears on the card (capitals) …………………………………………………………………
Signature…………………………………………………. Date…………………………………………………….