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Please complete as many sections of this form
as you like, without any obligation. Return to:

NEW ALLIANCE,
PO Box 13199,
LONDON SW6 6ZU


We respect confidentiality and do not pass
on personal information to other organisations.

1. REGISTRATION FORM

Name

 

Address

 

Daytime Tel

 

Fax

 

Evening Tel

 

Mobile

 

e-mail

 

Which aspects of the EU do feel strongest about?

 

Which anti-EU Groups do you actively support?

 

Which community or other campaigning groups do you support?

 

Do you hold any official positions?

 

Are there any skills you can offer us?

 

2. WOULD YOU BE ABLE TO ASSIST IN ANY OF THE FOLLOWING AREAS

Please Tick as appropriate

Leaflet distribution ___
Writing letters to the press ___
Lobbying community or political groups ___
Light clerical work (at home) ___
Fund raising ___
Research projects ___
Organising activities (such as a public meeting or street stall) ___

 

 

 

3. Financial Support

If you want an effective campaigning group, please make a contribution to New Alliance's running costs. Thank You. Make cheques payable to "NEW ALLIANCE" and send to the address above.

Name...............................................................................................................

Address............................................................................................................

Post Code.........................................................................................................

Sum donated.........................................................................................................

Date ....../....../......

 


OR

If you can help us with a Standing Order, to ensure we have a guaranteed income, please get in contact. (We do not publish bank details online).

Date this page was updated: 3 May 2012



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