Membership Application Form secretaryaog@gmail.org www.groworganicbristol.

org

Name(s): _______________________________________

_______________________________________
Membership Rates
For the remainder of 2017:
Address: _______________________________________
Individual 10 (* 5)
Household 15 (* 10)
_______________________ __________________
Please make cheques payable to
Postcode: _____________________ Avon Organic Group or pay by
bank transfer or preferably set up
an annual standing order
Tel: _______________________ Mobile: __________________
(payment due by 31st January):
__________________ Bank: Co-op
Account Name: Avon Organic
Email: _____________________________ Group
Account No: 65690882
Sort code: 08-92-99
_____________________________
Please return your completed
These records are exclusively for our own mailing list and information form and cheque (if applicable)
and will not be disclosed outside AOG without the express to:
agreement of individual members. Secretary, AOG
5 Boundary Road
I understand that my email address may be shared with other AOG
Coalpit Heath
members. BS36 2PU
Please tick box/es below as appropriate: * concession rate available for people in
receipt of Housing Benefit and Council Tax
I enclose cheque for my/our part-year subscription Benefit
of 10/15.
I/we have paid by bank transfer.
I/we will set up a standing order effective in January
for 15/20. Please send me a form.

Signed: _____________________________ Date: ___________

This section is entirely voluntary but provides useful information to the group.

For Information only:

I/we are a member of Garden Organic.

I/we are a member of the Soil Association.
I/we have an allotment. Site name: _________________________
I/we have a garden.
I/we am involved with a community growing group. Name of group: _______________________