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        A BetterWay to Govern        
    Advocat / Volunteer /Supporter / Member Application Form
    Membership number V / S / M (auto)
    Non-active supports are welcome, as are volunteer helpers & members
    The law requires that we know where all funds come from, so we have to ask for your details.
    You can fill in and submit this form on line, or print it off and send it in by post
    Anyone can be a supporter or member regardless of age, sex, nationality, or country of residence
    First Name
    Surname
    Address
    Land line telephone Best contact time =
    Mobile telelephone Best contact time =
    e-mail
    Age Group under 18 18 - 30 31 - 45 46 - 60 61-75 Over 75
    (insert 'YES' to select)
    I wish to be choice = 'x' Subscription choice = 'x' Paid by:- choice = 'x'
    Volunteer Vol / Adv £0 No payment
    Advocat Under 18 £3 On-line
    Supporter Regular £10 Cheque
    Member Over 60 £5 Bank X'fer
    Donor only Donatiion - enter amount P. Order
    Total paid Other
    Major Debit & Credit Cards, CHAPS Bank Transfers, Cleared Cheques, Postal Orders preferred.
    Please do not send cash
    Note: Since there is insufficiant time to set up specific on-line payments for A Better Way to Govern,
    if you wish to pay by Credit Card please call 01291 437050 to make payment over the phone.
    Your 3 main areas of interest
    1
    2
    3
    Present MP's name Party
    Parliamentary Constituency
    The ward in which you live (if known)
    Experience Campagn Media Rel NGO Chair Parish Coun Local Coun Other Gov
    Choice = 'x'
    Things you might be able to contribute to the campaign (insert 'x' to select):-
    - organisation - print posters Note that
    - canvassing - display posters there is no
    - stuff envelopes - print leaflets obligation
    - speaking - demonstrate to do
    - writing letters - telephoning anything,
    - writing articles - e-mailing but all help
    - attend other meetings is welcome
    - other things you offer
    If you cannot fill this in on line, scan and attach it to an e-mail, or fax to 01291 423759
    Date today =
       
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