Liberal Democrats Online: Membership Form

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Liberal Democrats Online: Membership Form

Name:
Address:
Town:
Post-code:
Party membership number:
Preferred e-mail address:
CIX e-mail address: (if any)
Delphi tag: (if any)
Telephone (day):
Telephone (evening):
Mobile: (if any)
Fax: (if any)
Constituency:
How did you find this site?:

Optional:

What would you like from LDO?
What do you think LDO's priorities should be?
How can you or would you like to contribute to LDO?
Of which other AOs or SAOs are you a member?

We now have 2 methods of payment:

  1. Regular standing order (as attached)
  2. Cheque payable to 'Liberal Democrats Online' with your party number written on the back

Minimum annual subscription rates are £5 waged - £1 unwaged. Ideally we would prefer people to give around £25 but recognise that not all members are able to do so.

Please send standing orders or cheques to: David Martin, 71A Princes Road, Richmond upon Thames, Surrey. TW10 6DQ.

Signature:

Date:


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Last updated: 04 October 1999. Created with Frontier and the CoffeeCup HTML Editor.

Comments? Questions? Suggested improvements? E-mail me at mtod@cix.co.uk.