The Mary Slessor Foundation Dundee, Scotland & Akpap Okoyong, Calabar, Nigeria Scottish Charity No. SC032781 Direct Debit Form

Please complete the boxes, print out this page and return it to:

Mary Slessor Foundation
Friends of Mary Slessor
9 Castle Street
Dundee
DD1 3AA
Scotland
UK

Please pay Friends of Mary Slessor a/c No.359601, sort code 302587 Lloyds TSB Meadowside, Dundee, DD1 9UD

the sum of annually/monthly until further notice starting on the day of
and debit my account No

Name:

Address:

Post Code:

Signature ........................................................................... Date ..........................................