Membership

Please print this form (Only the selected frame), complete, and send (with payment if applicable) to:

Catharine Browne
15 Third Avenue,
London,
W3 7RT

Categories of membership

Active Campaigner - will tell us you would like to become active on a particular campaigning issue

Active Supporter - will tell us you would like to fundraise or help at stalls or during Days of Action

General Member - will tell us you are willing to offer support through such actions as letter writing, consumer boycotts, making donations etc.

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MEMBERSHIP FORM [Costs: Individual Ł10, Unwaged, Ł5 Household Ł15]

Name___________________________ Email__________________________

Membership category (+ campaign issue of interest if relevant)

_______________________________Are you a member of national FOE?___

Address________________________________________________________

Tel. No. Eve._________________ Day/mobile__________________________

I enclose Ł_____ membership plus Ł_____ donation Total Ł_____ Date:_______
Please make cheques payable to Ealing Friends of the Earth

BANKERS ORDER To: [your bank’s name and address] _______________________________________________________________

Your sort code ___ -___-___ Account number__________________________

I would like to make a regular payment by Bankers Order monthly/annually* to the value of Ł______, amount in words_______________________________

To: Cooperative Bank [08-90-80] Account Number: 50466746

Please pay to Ealing Friends of the Earth on __/__/20__ and thereafter the same amount on the same day each month/year*

Your name and address____________________________________________

Signature____________________ Date____________ * delete as appropriate