Membership Application Form

SOSAC Subscription 2021

To apply for membership please complete this will record information only - please select your intended method of payment from the dropdown menu and follow instructions below
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
example@example.com
Phone Number
Group Name
Enter name of Group/Society/Organisation
PAYMENT VIA BACS

If paying directly into Bank Account - please specifiy the group name as a payment reference using details below:

Southend Arts Council, Barclays, A/C 10047201 , Sort Code 20-79-73

BY CHEQUE VIA ROYAL MAIL

If paying by cheque please send remittance to:

Southend Arts Council, 91a Southview Drive, Westcliff on Sea, SS0 9QE
Method of Payment
Should be Empty:

SOSAC Subscription 2021