Eric Liddell Centre, 15 Morningside Road, Edinburgh EH10 4DP, Tel: 0131 447 6394 or 0774 298 4459
Company registered in Scotland (company number: SC247239) at 15 Atholl Crescent, Edinburgh, and limited by guarantee.
| Your name | ......................................................................................... |
| Your address | ......................................................................................... |
| ......................................................................................... | |
| Bank name | ......................................................................................... |
| Bank address | ......................................................................................... |
| ......................................................................................... | |
| Sort code | ........................... Account No. .................................... |
Pay to Bank of Scotland, 8 Morningside Road, Edinburgh, EH10 4DD
Sort Code: 80 02 85 Account No. 53 91 51
the sum of (in figures) £............... (in words) ............................................
on (date of first payment) .............................. and thereafter on the same day in each succeeding month / quarter / year (delete as appropriate) until cancelled by me.
Signature .................................... date ...........................
Please return this form to the Scottish Council on Human Bioethics at the above address.