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Sri Lankan Psychiatrists Association (UK)
Association of Psychiatrists of Sri Lankan Origin Practicing in the United Kingdom
Dear SLPA (UK) Member,
Treasurer - SLPA (UK)
"Little Orchard",
261 Kimbolton Road,
Bedford,
Bedfordshire
MK41 8AF
You may print the form below and send it to the address below or click here for a printed version
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Sri Lankan Psychiatric Association (UK) Standing Order Form Your Name ..
Address ...
Contact Telephone No
Bank Details To the Manager: Name of your Bank . .. .. Address of your Bank. .. ..
Post Code
Bank Sort Code __ __ - __ __ - __ __
Account Number __ __ __ __ __ __ __ __ __ __
Please debit the sum of £ annually to the following Account until further notice
Name of Account: Sri Lankan Psychiatrists Association (UK) Name of Bank: HSBC plc Bank Sort Code: 40-10-02 Account Number: 82421437
First Payment Date: __ __ / __ __ / __ __
Your signature: Date:
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