Join with other Seniors and help us to create a fairer society

Seniors are ignored and exploited because they are isolated and fragmented, yet there are over 20 million of us - the largest democratic group in the country. It was Karl Marx who said: "United we stand, divided we fall !" and it applies just as much to Seniors as to anyone else. If we have the courage to stand up and be counted together, then we really do have the power to create a fairer and better society - not just for Seniors, but for everyone. We have by definition more experience than all the rest of the population and we really can change the world - if you will join us !

Please print out the following Membership Application/Renewal Form, fill it in, and send it to the address given. You will then become a member of the largest force for change for good in the country - and you will never regret it !

MEMBERSHIP APPLICATION/RENEWAL FORM

Please use capital letters, thank you

Individual Membership:

Last Name: Е.ЕЕЕЕЕЕЕЕЕ. First Name: ЕЕЕЕЕЕЕЕ.Е..

Plus Membership for your Partner: (optional)

Last Name ЕЕЕЕЕЕЕЕЕЕЕ First Name: ЕЕЕЕЕЕЕЕЕЕ

Address ....ЕЕЕЕЕЕЕЕЕЕ Telephone: ЕЕЕЕЕЕЕЕЕЕ.

ЕЕЕЕЕЕЕЕЕЕЕ Email: ..ЕЕЕЕЕЕЕЕЕЕЕ..

Town/City ЕЕЕЕЕЕЕЕЕЕЕ Date of Birth: ЕЕЕЕЕЕЕЕЕ

County: ЕЕЕЕЕЕЕЕЕЕЕЕ MP: ЕЕЕЕЕЕЕЕЕЕЕЕ...

Postcode: ЕЕЕЕЕЕЕЕЕЕЕ. Constituency: ЕЕЕЕЕЕЕЕЕ

Do you currently have a computer ? YES/NO Local Council ЕЕЕЕЕЕЕЕ...

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If you are willing to pay by Direct Debit please complete the alternative form below and leave this section blank. It will help us enormously by reducing time and administration costs.

Please send this form with a cheque for your annual subscription of

г12 (individual membership) or г18 (dual membership) payable to:

Senior Citizens Party (subscriptions).

If possible, to support our СElection Fighting FundТ, a donation will be greatly appreciated and help our cause. A separate cheque please, payable to:

Senior Citizens Party (donations).

I enclose my subscription of г . . . . . . . . and a donation of г . . . . . . . . .(optional)

Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . .

Please return this form and your cheque(s) to:

David Dunn, Senior Manager Public Sector and Community Development, Co-operative Bank,

PO Box 101, 1 Balloon Street, MANCHESTER, M60 4EP

By returning this form you give your consent to your personal data being processed. We will not disclose your details to third parties but they may be made available to other members of the Senior Citizens Party in order to develop the Party at local, regional and national level. If you object to this, please enter an X here [ ] and we will remove you from our mailing list.

AND THANK YOU FOR SUPPORTING SENIORS

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DIRECT DEBIT FORM

Senior Citizens Party

Instruction to your
Bank or Building Society
to pay by Direct Debit

Please fill in the whole form and send it to: Senior Citizens Party,
c/o Rapidata, 225 Three Bridges Road, Crawley, Sussex, RH10 1LG

Name and full postal address of your Bank or Building Society

Originator's Identification Number

To: The Manager

Bank/Building Society

Address

Postcode

Name(s) of Account Holder(s)

Instruction to your Bank or Building Society

Please pay Senior Citizens Party Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with the Senior Citizens Party and if so, details will be passed electronically to my Bank/Building Society.

Bank/Building Society account number

Signatures

Branch Sort Code

Reference

S

Date

Banks and Building Societies may not accept Direct Debit Instructions for some types of account

For Senior Citizens Party official use only. This is not part of the instruction to your bank or building society.

Please enter your Membership No. (without the year) after the letters SCP in the line above. If you are not sure of your membership number please telephone 0845 260 1215 for confirmation.

I wish to pay by direct debit my annual subscription of г12 on . . . . . . . . date and on 1^st January each subsequent year.

I wish to pay a dual membership annual subscription of г18 on . . . . . . .date and on 1^st January each subsequent year.
These amounts are to be paid to the Senior Citizens Party (subscriptions) account.

I wish to support the Senior Citizens PartyТs СElection Fighting FundТ by making a separate donation of г . . . . on the following date . . . . . . . each year to be paid to the Senior Citizens Party (donations) account.

Signed: ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ Date: ЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕЕ..

If you have not already done so, please complete the personal details overleaf and post this form to:
Senior Citizens Party, c/o Rapidata, 225 Three Bridges Road, Crawley, West Sussex, RH10 1LG
SCP DDF Page 4

This guarantee should be detached and retained by the Payer.

The Direct Debit Guarantee

╖ This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme.
The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society.

╖ If the amounts to be paid or the payment dates change the Senior Citizens Party will notify you 10 working days in advance of your account being debited or as otherwise agreed.

╖ If an error is made by the Senior Citizens Party or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid.

╖ You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us.