This membership form is for the organization Surfers Against Sewage. It collects contact information for members such as name, address, phone numbers and payment details. It offers both direct debit and credit card payment options for annual membership fees starting at £18 for unwaged individuals and £30 for families. The form also provides space for optional donations and features the organization's branding and address at the bottom.

1. Membership Form Flat Plan
Abygail Jones

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3. Slogan
Logo
Promotional Offer Info
Promotional
Offer:
percentage off
of
merchandise
Renew Your Membership
Name
Address
Home tel
Mobile
Email
D.O.B.
Membership number
Direct Debit
Name(s) of Account Holder(s)
Bank/Building Society Account Number
Branch Sort Code
Name/Address of Bank/Building Society
(UK banks only, The manager,
bank/building society,
Address, postcode)
Signature
Date
SAS ref
We can set up direct debits to
start from when your current
membership expires. No more
wasteful reminders & no more
missed pipelines.
Please pay SAS direct debits
from the account detailed in the
instruction subject to the
safeguards assured by the direct
debit Guarantee. I understand
that this information may
remain with SAS and if so,
details will be passed
electronically to my bank or
building society.
Credit/debit card or cheque Please make cheques/postal orders payable to Surfers Against Sewage
Please charge my Visa/MasterCard/Maestro/Visa Debit/Solo
Card no. (19 boxes)
Expiry date (4 boxes)
Issue no/Valid Date (4 boxes)
Security Code (3 boxes)
Signature
Membership
Donation
Total
(if you aren’t able to renew your membership at this moment in time
Please consider making a donation to help protect our oceans, waves
& beaches)
Banner
Address, website, phone number, registered number +VAT for company
Fundraising standards
Board logo
Organization identification
number: 830681
Direct debit logo
Payment options: I would like to pay by: Direct debit, credit/debit card, cheque
Annual: £18 Unwaged, £24 single, £30 family
Monthly: £1.50 unwaged, £2 single, £2.50 family, £5, £10, other (direct debit only)

4. Logo
Promotional Offer Info font:
Renew Your Membership
Main body font: Century Gothic
Payment Options
Direct Debit
Name(s) of Account Holder(s)
Bank/Building Society Account Number
Branch Sort Code
Name/Address of Bank/Building Society
(UK banks only, The manager,
bank/building society,
Address, postcode)
Signature
Date
SAS ref
We can set up direct debits to
start from when your current
membership expires. No more
wasteful reminders & no more
missed pipelines.
Please pay SAS direct debits
from the account detailed in the
instruction subject to the
safeguards assured by the direct
debit Guarantee. I understand
that this information may
remain with SAS and if so,
details will be passed
electronically to my bank or
building society.
Credit/debit card or cheque Please make cheques/postal orders payable to Surfers Against Sewage
Banner
Address, website, phone number, registered number +VAT for company
Fundraising standards
Board logo
Organization identification
number: 830681
Direct debit logo

5. Slogan
Logo
Promotional Offer Info
Promotional
Offer:
percentage off
of
merchandise
Renew Your Membership
Name
Address
Home tel
Mobile
Email
D.O.B.
Membership number
Payment Options
Direct Debit
Name(s) of Account Holder(s)
Bank/Building Society Account Number
Branch Sort Code
Name/Address of Bank/Building Society
(UK banks only, The manager,
bank/building society,
Address, postcode)
Signature
Date
SAS ref
We can set up direct debits to
start from when your current
membership expires. No more
wasteful reminders & no more
missed pipelines.
Please pay SAS direct debits
from the account detailed in the
instruction subject to the
safeguards assured by the direct
debit Guarantee. I understand
that this information may
remain with SAS and if so,
details will be passed
electronically to my bank or
building society.
Credit/debit card or cheque Please make cheques/postal orders payable to Surfers Against Sewage
Please charge my Visa/MasterCard/Maestro/Visa Debit/Solo
Card no. (19 boxes)
Expiry date (4 boxes)
Issue no/Valid Date (4 boxes)
Security Code (3 boxes)
Signature
Membership
Donation
Total
(if you aren’t able to renew your membership at this moment in time
Please consider making a donation to help protect our oceans, waves
& beaches)
Banner
Address, website, phone number, registered number +VAT for company
Fundraising standards
Board logo
Organization identification
number: 830681
Direct debit logo

6. Campaign poster on the back of the
membership form.