Registration

AFC Portchester Football Club

Wicor Recreation Ground, Cranleigh Road, Portchester, PO16 9DL

Telephone: 02392 272701 Email: afcportchester@fab.uk.net

	August 2020 to July 2021
Signed for One Team	£25.00
Signed for Two Teams	£35.00
Training Only	£12.00
Single Membership (included in first charge)	£35.00
Second Membership + (included in first charge)	£25.00

Please select Single membership for your eldest or only child signing for the club.

Please select Second membership for children that have older siblings signed for the club.

Customer Ref:

Schedule

Service/Schedule:

Termination:

Take certain number of debits

Number of Debits:

Payment Information

Payment Day:

2022

First Payment Date:

01 March 2022

The first amount (if different to the regular amount) should be:

£ 60.00

Total First Payment:

I wish to pay a regular Direct Debit of:

£25.00

Personal Details

Company name

Title

First name

Surname

Date of birth

Line1

Line2

Line3

Line4

Post code

Home phone number

Mobile phone number

Work phone number

Additional Information


1. Child's Name:

Instruction to your Bank or Building Society to pay by Direct Debit

EAZY COLLECT RE AFC PORTCHESTER, Wicor Recreation Ground, Cranleigh Road, Portchester, PO16 9DL

Service User Number:

Account holder name

Account number

Bank sort code

Please tick to confirm you are the only person required to sign for this account

Checking the box indicates that I am the Bank/Building Society holder and no authority other than my own is required. If more than one person is required to authorise debits from the account, you are unable to setup a direct debit online.