Application Form
SouthEast Sussex Democracy Movement

Application for Membership of the SouthEast Sussex branch of the Democracy Movement - a non-party campaign to keep the £ and to restore true democracy to Britain.

Please use one application per person or photocopy if necessary.

Surname:................................................................................

Firstname:...............................................................................

Address:.................................................................................

..............................................................................................

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Country:.............................Post (or Zip) Code:.........................

Telephone number (optional):..................................................

E-mail (optional):...................................................................

Please enrol me as a member of the local Democracy Movement. I understand that as a member, I shall receive news bulletins every other month, that I shall be notified of all local public meetings and that my name will be added to the list of national supporters/campaigners to keep the £ and against an EU State.

I enclose a cheque/postal order for a minimum of £6 for one year (£9 for overseas members requiring postal bulletins). If an additional amount is enclosed, please enter the amount here: £........... as a donation.

(Please make cheques payable to 'SES Democracy Movement')

Please return this application and accompanying cheque/postal order to:

Democracy Movement
SouthEast Sussex Branch
44 Collington Rise, Bexhill-on-Sea
East Sussex TN39 3RS

Membership cards will be issued on receipt. Thank you for your support.