National Association of Maths Advisers

National Association of Maths Advisers Application Form

Name:

______________________________________

Job Title:

___________________________________

LEA/Company:

______________________________

Business Address:

___________________________

_______________________________________________

This address may/may not be shared with sponsors of the association for the distribution of conference materials. (Please delete as appropriate)

Telephone:

__________________________________

Fax:

________________________________________

email:

______________________________________

Home Address:

_____________________________

_______________________________________________

This address may/may not be shared with sponsors of the association for the distribution of conference materials. (Please delete as appropriate)

Telephone:

__________________________________

Fax:

________________________________________

email:

______________________________________

Signed (applicant):

__________________________

Signed (sponsor):

__________________________

Standing Order Mandate

To:

________________________ (Bank/Building Society)

Branch Address:

____________________________

_______________________________________________

Sort Code _ _ - _ _ - _ _ (Usually at the top right corner of your cheque)

Account Number _ _ _ _ _ _ _ _ (Usually at the foot of your cheque)

Please pay the sum of £30.00(thirty pounds on _____ day _____ month _____ year and thereafter annually on 1 September) to:

Account: The National Association of Mathematics Advisers (NAMA)
Bank: National Westminster Bank plc
Branch: Solihull Branch
Address: PO Box 4815
4 High Street
SOLIHULL B91 3WL

Sort Code: 55 - 50 - 15
Account Number 56262965

This Standing Order should replace any existing Order payable to NAMA.

Signed _____________________ Date_____________________