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, 35 North Lotts, Dublin 1, D01 A3E0, Ireland
     Phone: 01-872-7798      Email: info@ipsc.ie      Website: http://www.ipsc.ie

Standing Order Mandate

To the Manager,
Name of your bank:_______________________________________________________________ Address of your bank:______________________________________________________________
Please pay:	The Ireland-Palestine Solidarity Campaign
	Account No: 23591022     Sort Code: 93-21-08 IBAN: IE63 AIBK93 2108 2359 1022 BIC No: AIBKIE2D
	AIB, 140 Lower Drumcondra Road, Dublin 9
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 IBAN No:	_____________________________________
Your signature(s):	__________________________________                 __________________________________
Date:	________________________