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NICARAGUA SOLIDARITY
CAMPAIGN ACTION GROUP
(NSCAG)
Membership Form. You can use this for
joining or renewing your
membership.
Please tell us if you have changed your contact details.
To print this form, click on File/Print or the 'Print' button in
the toolbar at the top of your browser.
Waged individual........£ 25 Unwaged individual........£ 7.50
Household.........£ 25
Trade Union branches and Student Groups .........£ 40
Trade Union regions......£75
Name:.............................................................................................................
Address:..........................................................................................................
......................................................................................................................
Tel:.................................................e-mail:......................................................
Pay by cheque (if a trade union payable to NSCAG. All others
payable to NSC)
I enclose £...... to become a member. I enclose a donation of £.......
Total £.......
I enclose £......to renew my membership. I enclose a donation of
£..... Total £.......
Standing Order Form:
To the Manager: (write in your bank/building society's name and address)
.............................................................................................................................
Account Name (Name of your bank account)
.................................................................
Account Number.............................................
Sort Code ............/........./.........
Please pay Nicaragua Solidarity Campaign......£.....................
every month/year starting on ........./........./.........(date) until further
notice.
Signed.......................................
Date................................................
Credit A/C of: Nicaragua Solidarity Campaign,
Unity Trust Bank, 4 The Square, 111 Broad St, Birmingham B15 1AR
Sort Code 08-60-01 Account no. 20129945
Return to
NSCAG, 86, Durham Rd, London N7 7DT
020 7561 4836 nscag@nicaraguasc.org.uk
Please do not send this direct to your bank. We will do that having taken a
copy. |
