Eccleshall Branch Conservative Future

Last updated Monday August 25, 2008

Eccleshall Branch Conservative Future

(Delete as Appropriate)

Renewal of Membership – Membership Number _______________________
New Membership Application
I do/do not wish to also become a member of Conservative Future (Delete as appropriate)

Mr/Mrs/Miss/Ms/ Other __________________

Mr and Mrs____________

Other: ________________

Address:______________________________________________________________

________________________________________________ Postcode ____________

I/We wish to contribute the following amount: £15 £20 £25 £30 £35 £40 £45 £50

NB anyone under the age of 23 minimum contribution is £3 those over 23 the minimum is £15

Method of payment

Enclosed is a subscription of £___________ (Cheques payable to Eccleshall Branch Conservative Association)
Bankers Order Conservative Membership

To………………………………… Bank

Branch…………………………………

Address………………………………..

…………………………………………

Account Number………………………..

Members Name…………………………

Address…………………………………

………………………………………….

Please pay to the Eccleshall Branch Conservative Association A/C Number 03511200 Natwest Bank, 13 High Street, Eccleshall.

Sort Code 52-41-10

The sum of £

On…………………………… (date)

And also a like amount on day of each year succeeding until this order is cancelled

Signed ………………………………

Date ……………………………….

Please print off and send this form to:

Mathew Richardson c/o

Ivan Jennings 18 Chapel Terrace, Stafford, ST163AH