Membership Form Conservative Party & Conservative friends of NH

Membership Form Conservative Party & Conservative friends of NH
Your details
Please fill and return this form even if you would not like to pay.
Title*
Name*
First NameMiddle NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Date of Birth*
DayMonthYear
Date
*We collect every member's date of birth for checking eligibility.
Email*
example@example.com
* This email address will be used to send your membership confirmation & Party activites.
Phone Number*
Please enter a valid phone number.
Tick if you want to be a member of Conservative friends of NHS.Would you like be involved in politics as Councillor/MP.Would you like to attend meetings/dinners
Are you member of Conservative party already?*
YesNo
Your Membership Number if you are a member already.*
Your place of work*
Your work status*
Fee (Optional)
Membership CFONHS Free
Fee Conservative Party Membership
£25.00 Yearly
£2.09 Monthly
Your Account name blanks Your Bank’s name blank
Sort Code
Account No
Signature
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Your details