Join UKIP Yorkshire & North Lincolnshire
To print this form off, press print on your browser.
| Please return to: | UKIP YNL Headquarters 108 Main Street Wressle Nr Selby North Yorkshire YO8 6ET |
| I should like to join the UK Independence Party |  |
| I should like to help with leafleting etc. | |
Membership is £20.00 per annum (£10.00 for pensioners, students and benefit recipients)
Please make your cheques payable to UKIP Y & N L
| Membership: | ____________ |
| Donation: | ____________ |
| TOTAL: | ____________ |
| Name: | _______________________________________ |
| Address: | _______________________________________ |
| _______________________________________ | |
| Post Code: | _______________________________________ |
| Telephone: | _______________________________________ |
| email: | _______________________________________ |
| Signature: | _______________________________________ |
| Date: | _______________________________________ |