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Please fill in the whole form using a ball point pen and send it to: NICSSA Sport & Leisure The Pavilion, Stormont Stormont Estate Upper Newtownards Road
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Document Date: 2014-03-21 12:04:54

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City

Payroll Town / Belfast / /

Company

Joint SA / Reference N I C S S A / The Manager Bank / /

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Facility

Leisure The Pavilion / /

IndustryTerm

bank/building society / Bank/building society account number / bank / /

Organization

Address Signature / building / Direct Debit Service / Pavilion / www.nicssa.co.uk Department / /

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URL

www.nicssa.co.uk / /

SocialTag