Annual Quiz Night

Name

Membership number

Number in your group

Names of others in your group (Please state NONE if applicable)

Payment amount

Number @ £17.50

Please state payment method. Our preferred method is BACS

Paid by

BACS to HSBC Bank - A/C No 71781472 - Sort Code 40-34-26

Paid by

Cheque made payable to FRIENDS OF OSBORNE

BACS reference (if payment has been made via bank transfer)

If possible, please use 'Quiz' as your BACS reference

Date of BACS payment

Date cheque sent (if payment by cheque) to arrive by 6 September

Cheques to be sent to Friends of Osborne, Osborne House, East Cowes, Isle of Wight, PO32 6JX

Please use this area to inform us if you have any mobility issues or dietary requirements.