IPSC Notification

I have created a standing order in favour of the IPSC.

Monthly amount:____________________         Starting date:_____________________

Your name:______________________________________________

Your address: ______________________________________________________________________________

Your phone number: ______________________           Your email address: ______________________________
Please tick a box:
I want to join the IPSC       I am already a member       I do not want to become a member.

Send this form to the IPSC for our records. Our contact details are:
Ireland-Palestine Solidarity Campaign, Room 5, 64 Dame Street, Dublin 2
     Phone: 01-677-0253      Email: supportpalestine@ireland.com      Website: http://www.ipsc.ie

(In the South - € Euro)

Standing Order Mandate

To the Manager,
Name of your bank:______________________           Address of your bank:_________________________________
Please pay:	The Ireland-Palestine Solidarity Campaign
	Account No: 42327706     Sort Code: 90-00- 84
	Bank of Ireland, St. Stephen's Green, Dublin 2
Amount (in figures):______________                  (in words):___________________________________________
On the     _______________    day of every month, starting on     ______/_______/________    (date of first payment)
From my/our account:
Your account name(s):	__________________________________                 __________________________________
Your account number:	___________________         Your bank sort code:__________________
Your signature(s):	__________________________________                 __________________________________
Date:	________________________

(In the North - £ Sterling)

Standing Order Mandate

To the Manager,
Name of your bank:______________________           Address of your bank:_________________________________
Please pay:	IPSC-Fermanagh
	Account No: 33094226    Sort Code: 90-50-45
	Bank of Ireland, Belleek, Co. Fermanagh
Amount (in figures):______________                  (in words):___________________________________________
On the     _______________    day of every month, starting on     ______/_______/________    (date of first payment)
From my/our account:
Your account name(s):	__________________________________                 __________________________________
Your account number:	___________________         Your bank sort code:__________________
Your signature(s):	__________________________________                 __________________________________
Date:	________________________