CUBA SOLIDARITY CAMPAIGN
MEMBERSHIP AND RENEWALS FORM
(Print this page and send it to the address provided)
Please complete all the details below so we can check our records and return
to:
CSC, c/o UNITE Woodberry, 218 Green Lanes, London, N4 2HB.
New member or Renewal: NEW / RENEWAL
Name: ________________________________________________________________
Address: ______________________________________________________________
______________________________________________________________________
______________________________________________________________________
Home Telephone : ________________________________________________________
Work Telephone : ________________________________________________________
Trade Union : ___________________________________________________________
Email Address : __________________________________________________________
Are you a student? YES / NO College : ______________________________________
Would you like to be contacted by the CSC local group in your area? YES / NO
=============================================================
How would you like to pay? Please tick just one of the lines below.
____ I am waged and have enclosed a cheque / PO for £15
____ I am unwaged and have enclosed a cheque / PO for £5
____ I would like to pay by standing order and have completed the form below
=============================================================
Standing order form (Please return to CSC - not your Bank)
Your Name : __________________________________________________________
Address : _____________________________________________________________
Account Number : ______________________________________________________
Sort Code : _____________________________________________________
At (Name & address of bank) : ____________________________________________
____________________________________________________________________
Pay Cuba Solidarity Campaign, Co-operative Bank, 1 Islington High Street, London
N1 9TR,
Sort code 08 90 33 Account Number 50425169
£
___________every month / year starting on (date)______________until further
notice.
Signature _________________________________________________
For CSC Office Use
Payment Received and Processed
New Members Pack Sent
Database Updated