EFOE Membership application form

Please print this form (only the selected frame), complete, and e-mail Catharine Browne at catharinebrowne@aol.com for details of where to send it.

Categories of membership

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MEMBERSHIP FORM (Costs: Individual 10, Unwaged 5, Household 15)

Name___________________________ Email__________________________

Membership category (+ campaign issue of interest if relevant)

_______________________________Are you a member of national FOE?___

Address________________________________________________________

Tel. No. Eve._________________ Day/mobile__________________________

I enclose _____ membership plus _____ donation Total _____ Date:_______
Please make cheques payable to Ealing Friends of the Earth

BANKERS ORDER To: [your bank’s name and address] _______________________________________________________________

Your sort code ___ -___-___ Account number__________________________

 

I would like to make a regular payment by Bankers Order monthly/annually* to the value of ______, amount in words_______________________________

To: Cooperative Bank [08-90-80] Account Number: 50466746

Please pay to Ealing Friends of the Earth on __/__/20__ and thereafter the same amount on the same day each month/year*

Your name and address____________________________________________

Signature____________________ Date____________ * delete as appropriate