Untitled Document
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Name of affiliating organisation
Name of secretary
Title
Mr
Miss
Mrs
Ms
Other (please specify)
First name
Surname
Mailing address
Postcode
Contact telephone number
E-mail address
Size of organisation
Student group (£25)
Local organisation or local trade union (£50)
Regional trade union (£100)
National organisation, less than 100,000 members (£200)
National organisation, more than 100,000 members (£400)
National organisation, more than 500,000 members (£600)
Optional additional donation
£