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Liberal Vannin Party Application Form

I am not a member of any other political party or organisation?

Yes □

No □

Full Name ...................................................................................................................... Address ......................................................................................................................... ....................................................................................................................................... Post Code: ............................................... Tel No: ....................................................... Mobile: ..................................................... Email: ......................................................... ----------------------------------------------------------------------------------------------------------------We welcome your subscription Full membership for the year is £18 Concessionary Subscriptions of £6 are available to anyone who is a pensioner, full time student or people in receipt of Income support, Incapacity Benefit or JSA. Yes, I qualify for concessionary membership rates as I am □ Pensioner □ Full Time Student (ID card required) □ Income support, Incapacity Benefit or JSA (Proof of entitlement) Any amount in excess of membership would be gratefully received and treated as a donation.

Annual membership

Standard rate

£18.00

£………

Annual membership

Concessionary rate

£6.00

£………

£………………

£………

Total payment

£………

Donation

I would like to pay by cheque □ Cash □ Please make cheques payable to Liberal Vannin Party ----------------------------------------------------------------------------------------------------------------I would like to be an active member

Yes □ No □

I would like to be considered as a future MHK/Commissioner

Yes □ No □

Sent News Letter

Yes □ No □

Sent VideoCast

As this is an election year will you be able to give support Delivering leaflets Poling stations

Yes □ No □ Yes □ No □

Canvassing

Yes □ No □ Yes □ No □ Yes □ No □

Post to: Juan Cottier, 34 Cronk Grianagh, The Strang, Union Mills, IM4 4RN

LVP Membership Form  

Enrolment Form For LVP Membership

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