Merchant Taylors Old Boys Association
(Old Crosbeians)
APPLICATION FOR MEMBERSHIP
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Surname (BLOCK CAPITALS) .. |
Title (Mr, Rev, etc. or Rank) |
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Given names (in full) .. |
Awards (Medals, Honours etc.) |
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(Underline preferred name) |
Date of Birth |
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Degrees / Professional Qualifications |
At School from: . to |
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Full Private Address: . |
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Postal/Zip Code |
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Telephone Numbers: (T) (F) (M) |
E-mail Address: |
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Occupation: . |
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Full Business Address: . |
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Postal/Zip Code |
Country (if not UK) |
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Telephone Numbers: (T) (F) |
E-mail Address: |
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Parents or Second Address: |
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Academic and/or Sporting Achievements at School: |
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Further Education / Later Achievements: |
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Name of Any Relative who is a Member of the Association: |
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HIS years at school: From to . |
Relationship: |
These details will be entered into our private computerised records and made available only to other Members of the Association.
PLEASE RETURN TO: Hon. Membership Secretary, MTOBA, Merchant Taylors School, Crosby, Liverpool L23 0QP.
BANK ORDER FORM
To: .. .. Bank
Branch Address:
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Code No: |
Bank: |
Account to be Credited |
Amount |
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20-10-84 |
Barclays Bank plc |
Merchant Taylors Old Boys Association |
£10.00 |
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18-22 Liverpool Road |
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Crosby, Liverpool L23 5SF |
Account No. 50632309 |
Please make the first payment immediately if dated between 16th March
and 30th September. Then, on 15th March annually, until
further notice from me in writing.
Name (BLOCK CAPITALS) . Signature:
Address: .
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Account No: . Sort Code: Date: .
This Order cancels any previous Order