MEMBERSHIP or RENEWAL FORM

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 Action Group £.....................

every month/year starting on ........./........./.........(date) until further notice.

Signed....................................... Date................................................

Credit A/C of: Nicaragua Solidarity Campaign Action Group,
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.