CUBA SOLIDARITY CAMPAIGN
AFFILIATION FORM
(Print this page and send it to the address provided)
Please complete all the details below so we can check our
records. Return to:
CSC, Red Rose Club, 129 Seven Sisters Road, London N7 7QG.
New affiliation or renewal: NEW / RENEWAL
Name: ___________________________________________________________
Name of contact : _____________________________________________________
Address: ___________________________________________________________
___________________________________________________________________
____________________________________________________________________
Telephone : ___________________________________________________________
Fax : ___________________________________________________________
Email Address : ________________________________________________________
Type of organisation: LOCAL / REGIONAL / NATIONAL
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How would you like to pay? CASH / STANDING ORDER
Local organisations £20 Regional £40
National less than 50,000 members £75 50,000-100,000 members £100
100,000-500,000 members £150 more than 100,000 £200
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Standing order form (Please return to CSC - not your Bank)
Name : _________________________________________________________________
Address :________________________________________________________________
Account Number_________________________________________________________
Bank Building Soc._______________________________
_______________________________________________
_______________________________________________
______________________________________________
Pay Cuba Solidarity Campaign, Co-0perative Bank, 1 Islington High
Street, London N1 9TR
Sort Code 08 90 33 Account Number: 50425169
£ _________every month/year starting on(date)__________________ until further
notice.
SIGNATURE:___________________________________________________
For CSC Office Use
Payment Received and Processed
New Members Pack Sent
Database Updated