I would like to help the Friends.

Name........................................................................................................................................................

Address ...................................................................................................................................................

.......................................................................................................  Post Code.......................................

EITHER

A.  I enclose a donation of £...................(GBP).
          (Please make cheques payable to Friends of Kidderminster Town Station Group)

B.   I wish to make payments by Bankers Order of £...................(GBP). per month.
          (Please completed the authorisation form below.)

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------

BANKERS ORDER

The Manager...................................................................Bank plc.     Sort Code....................................

Address ...........................................................................................................................................

Account Name..................................................................... Account No................................................

Please pay the sum of £....................(GBP) on the 1st day of each month until further notice,

commencing on the 1st /......................./  20..........

to  FRIENDS OF KIDDERMINSTER TOWN STATION GROUP
     LLOYDS BANK plc        MERRY HILL CENTRE   
     SORT CODE 30-91-22       ACCT NO. 00038248

Banker please quote Ref No:............................................................ (Treasurer to allocate number)

Your Name.............................................................................................................................................

Address .................................................................................................................................................

............................................................................................   Post Code...............................................

Signed.....................................................................................   Date....................................................

Please return this form to
The Treasurer, Friends of Kidderminster Town Station Group,
39, Drew Crescent,  Pedmore,  Stourbridge,  West Midlands,  DY9 0UX, England
or call Bob Brown   +44 (0)1384 373733