Membership Form

Text Box: Liberal Democrat Friends of Israel LDF! PO BOX 57769 LONDON NW11 1GF Phone: 020 8455 5140 Fax: 020 8209 3496 www.ldfi.org.uk
MEMBERSHIP FORM (Please use block capitals) Date: TITLE: (please circle): Mr Mrs Miss Ms Other: FULL FORENAME: …………………………………………………………………………. SURNAME: …………………………………………………………………………………... ADDRESS: …………………………………………………………………………………… ……………………………………………………… POST CODE: ……………………….. EMAIL ………………………………………………………………………………………… TELEPHONE: (Home): ……………………………………………………………………... (Mobile): …………………………………………………………………….. OCCUPATION: ………………………………………………………………………………. NAME OF CONSTITUENCY: ………………………………………………………………. Are you (please circle if applicable): AN ACTIVIST A MEMBER OF THE LIB DEM YOUTH AND STUDENTS A STUDENT A LOCAL COUNCILLOR A PEER A VOTING CONFERENCE REPRESENTATIVE A PROSPECTIVE PARLIAMENTARY/EURO CANDIDATE AN MP OTHER: ……………………………………………………………………………………… Where did you hear about the Liberal Democrat Friends of Israel? ………………….. ………………………………………………………………………………………………… Please return this form, together with a donation (we recommend a minimum of £10 per person or £5 for students) to: LDFI PO BOX 57769 London NW11 1GF

To contact us

Phone: 020 8455 5140

Fax: 020 8209 3496

Or emails as under officers (see home page, left hand side).

Postal Address LDFI PO BOX 57769 London NW11 1GF