Alliance Logo

Please complete as many sections of this form
as you like, without any obligation. Return to:

NEW ALLIANCE,
PO Box 13199,
LONDON SW6 6ZU


We respect confidentiality and do not pass
on personal information to other organisations.

1. REGISTRATION FORM

Name

 

Address

 

Daytime Tel

 

Fax

 

Evening Tel

 

Mobile

 

e-mail

 

Which aspects of the EU do feel strongest about?

 

Which anti-EU Groups do you actively support?

 

Which community or other campaigning groups do you support?

 

Do you hold any official positions?

 

Are there any skills you can offer us?

 

2. WOULD YOU BE ABLE TO ASSIST IN ANY OF THE FOLLOWING AREAS

Please Tick as appropriate

Leaflet distribution ___
Writing letters to the press ___
Lobbying community or political groups ___
Light clerical work (at home) ___
Fund raising ___
Research projects ___
Organising activities (such as a public meeting or street stall) ___

 

 

 

3. Financial Support

If you want an effective campaigning group, please make a contribution to New Alliance's running costs. Thank You. Make cheques payable to "NEW ALLIANCE" and send to the address above.

OR

Make a Standing Order to ensure we have a guaranteed income.
Please complete the following Mandate


To:

The Manager..............................Bank/Building Society. Sort Code.............

Address of bankers....................................................................................

..................................................................................................................

Please implement standing order payments of .........per month/quarter/year (please delete as appropriate)

from account number .............................commencing......../......./........ (date) until further notice to

New Alliance, account number 58771183, sort code 72-00-06 at Alliance and Leicester Commercial Bank PLC, Bootle, Merseyside. GIR 0AA

From:

Name...............................................................................................................

Address............................................................................................................

Post Code.........................................................................................................

Signed..............................................................................................................

Date ....../....../......

 


Date this page was updated: 23 May 2005



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