Name
Phone
MPT Subscription Form
Address
Postcode
Country
I would like to subscribe to Modern Poetry in Translation (please tick relevant box):
Subscription Rates (including postage by surface mail) UK Overseas
❑ One year subscription (2 issues)
£22 £26 / US$ 52
❑ Two year subscription (4 issues) with discount
£40 £48 / US$ 96
Student Discount*
❑ One year subscription (2 issues)
❑ Two year subscription (4 issues)
£16 £20 / US$ 40
£28 £36 / US$ 72
Please indicate which year you expect to complete your studies 20 . . .
Standing Order Discount (only available to UK subscribers) ❑ Annual subscription (2 issues) £20 ❑ Student rate for annual subscription (2 issues)* £14
Payment Method (please tick appropriate box)
❑ Cheque: please make cheques payable to: Modern Poetry in Translation. Sterling, US Dollar and Euro cheques accepted.
❑ Standing Order: please complete the standing order request below, indicating the date you would like your first payment to be taken. This should be at least one month after you return this form. We will set this up directly with your bank. Subsequent annual payments will be taken on the same date each year. For UK only.
Bank Name
Branch Address
Post Code
Sort Code
Account Number
Account Name
❑ Please notify my bank
Please take my first payment on
......../......../......... and future payments on
the same date each year.
Signature:
Date........../........./............
Bank Use Only: In favour of Modern Poetry in Translation, Lloyds TSB, 1 High St, Carfax, Oxford, OX1 4AA, UK a/c 03115155 Sort-code 30-96-35
Please return this form to: The Administrator, Modern Poetry in Translation, The Queen’s College, Oxford, OX1 4AW administrator@mptmagazine/www.mptmagazine.com