When completing this form please WRITE CLEARLY, add your signature and enclose payment or online reference.
Email scan of signed form to: wfpsc@yahoo.com
Post to: WFPSC, c/o 458 Hoe St, London E17 0HD
FIRST NAME(S):
SURNAME:
Address - Street:
Address - Town:
Address - Postcode:
Email:
Facebook:
Mobile:
A. NATIONAL MEMBERSHIP SUBSCRIPTION:
Subscription to National PSC gives you both local & national membership rights. Circle relevant rate for you (below) and enclose cheque payable to “PSC”:
Individual Subscription: £24 waged / £12 unwaged
Trade Union Affiliation: £25 local / £50 regional / £100 national
B. OPTIONS TO DONATE TO LOCAL WFPSC WORK:
- Enclose cash / cheque payable to “WFPSC”, amount £__________
- Online, via PayPal (see web button, top left). Your PayPal payment reference________
- Online, via your own bank’s website (see mandate details below for Acc info)
Your Payment ref ________ Donation amount £__________
- Standing Order mandate from your bank to WFPSC:
Bank Name:
Bank Address:
Bank Postcode:
Acc No:
Sort Code:
Please pay £__________ Mnthly / Qtly / Yearly donation to Unity Trust Bank, Acc Name: Waltham Forest Palestine Solidarity Campaign, Acc No: 2022 2185, Sort Code: 08-60-01
From [date] __ / __ / 2012 until further notice.
- Standing Order mandate from your bank to WFPSC:
Bank Name:
Bank Address:
Bank Postcode:
Acc No:
Sort Code:
Please pay £__________ Mnthly / Qtly / Yearly donation to Unity Trust Bank, Acc Name: Waltham Forest Palestine Solidarity Campaign, Acc No: 2022 2185, Sort Code: 08-60-01
From [date] __ / __ / 2012 until further notice.
YOUR SIGNATURE:
DATE:
DATE:
