[On line protest] [Events] [Material Aid] [Membership form] [Brigades] [Facts File on Cuba] [Cuba Si! index] [Other Cuba links] [CSC Contact] [Web contact] [Sponsors] [contents overview]

For CSC Office Use :

Payment Received and Processed

New Members Pack Sent

Database Updated

CUBA SOLIDARITY CAMPAIGN
AFFILIATION FORM

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

=========================================================================

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

=========================================================================

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:_______________________________________________________________