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MEMBERSHIP APPLICATION FORM

The Democratic Party is a grass roots operation. Help us to return Britain to Democracy by joining with other ordinary men and women who put the good of their country before the party. A subscription of 10.00 ensures membership until 31st December 2001. Please print this membership application form, complete and send to:

The Democratic Party
Enigma House
Enigma Business Park
Malvern
Worcestershire WR14 1GD

The Democratic Party is a Private Company Limited by guarantee (No. 3541915)

PLEASE COMPLETE USING BLOCK CAPITALS

Title: (Mr./Mrs./Miss/Ms./Dr./etc.)..................................................................
Name: ...........................................................................................................
Address: .......................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
...............................................Post Code:......................................................
Tel/fax No:......................................................................................................
Email: ............................................................................................................
Web page:......................................................................................................

I enclose a cheque/postal order for my subscription of ....................................
(Single:10.00/unwaged: 5.00)
made payable to: The Democratic Party

I accept and support the aims of the Democratic Party.

Signed:.............................................................................................................