Application Form

Southend District Pensioner’s Campaign

 

Help Yourselves By Joining Us!

 

 

APPLICATION FOR MEMBERSHIP

 

NAME (Mr/Mrs/Miss)………………………………………

 

ADDRESS………………………………………………………………………………………………………….

……………………………………………………………

 

POSTCODE……………….

 

PHONE/MOBILE…………………………………….. .………….………………..…………………………………………

EMAIL…………………………………………………

 

SUBSCRIPTION FEES £12 PER PERSON PER ANNUM

 

CHEQUES & DONATIONS PAYABLE TO: SOUTHEND PENSIONERS CAMPAIGN

 

Please print out completed form

 

AND SEND TO THE SECRETARY:

91 BRIGHTWELL AVENUE, WESTCLIFF-ON-SEA, ESSEX SS09EG TEL: 01702 341047

jean_howes@hotmail.co.uk