Socialist Civil Liberties Association
either print off this Form, complete and send as E-mail Attachment OR  mail hard-copy to >

• For England/Wales: Treasurer Robin Cherney or 24 Grace Way Stevenage Herts SG1 5AA

• For Scotland: Michael Kelly or 
  50 Aytoun Road Glasgow  G41 5HE

APPLICATION FORM
Individual Membership

My name is (full)..........................................

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Address ......................................................

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Contacts (tel) (fax) (mobile) (E-mail) 

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Constituency LP ............................ ............ Party Membership No

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Having considered the SoCLA Constitution,
I hereby APPLY for Membership
I enclose/will send (a) £5 Individual
(b) £ ............. (donation) = Total £.............

Signed..............................................
Date ................. .............................
 

APPLICATION FORM
for Affiliation

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