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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
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Name |
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Address |
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Daytime Tel |
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Fax |
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Evening Tel |
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Mobile |
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Which aspects of the EU do feel strongest about? |
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Which anti-EU Groups do you actively support? |
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Which community or other campaigning groups do you support? |
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Do you hold any official positions? |
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Are there any skills you can offer us? |
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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