Cambridge Student Liberal Democrat Membership Form

Document Sample
Cambridge Student Liberal Democrat Membership Form Powered By Docstoc
					Cambridge Student Liberal Democrat Membership Form
Please fill out all sections in block capitals, and return with cheque to the Secretary as
listed in the “People” section of the website.

Title:                     Mr / Miss / Ms / Mrs                         [delete as appropriate]

Forenames:

Surname:

University:                Cambridge University / Anglia Ruskin University
                                                               [delete as appropriate]

College (if needed):

Term Time Address:



Term Time Phone:           (01223)

Vacation Address:



Mobile Phone:              07

Date of Birth:                                 Expected Graduation: 20

University Email:

    o    I am already a party member and I would like to join CSLD for life
                                  (Please send a cheque for £1)        Membership no:

    o    I would like to join CSLD and join the national Liberal Democrats for 1 year
                                                                                (Please send a cheque for £1)
    o    I would like to join CSLD for life and would like to pay my national membership by Direct Debit
                                         (Please send a cheque for £1 and a completed Direct Debit mandate
                                              (which we will send you following your application) – your bank
                                account will be debited £3.00 when your national membership is processed)
    o    I would like to join CSLD for life but not the national Liberal Democrats party
                                                                                (Please send a cheque for £1)
    o    I would like to join CSLD for one year but not the national Liberal Democrats party
                                                                                (Please send a cheque for £1)