Member

MEMBERSHIP APPLICATION FORM to The UK Independence Party The party believes that our Parliament should be directly and solely accountable to the electorate of the United Kingdom, not subservient to the political institutions of the European Union. Continued membership of the European Union is totally incompatible with this principle. Furthermore, the party will campaign to restore accountability at all appropriate levels of government in order to re-establish electorate's confidence in our democracy at both local and national level. Title.................. Forename(s)............................................................ Surname........................................................................................... Address............................................................................................ Town............................................................................................... County............................................ Postcode.................................. Telephone (Work) .............................. (Home) ................................ Email (write very clearly) .................................................................. One year membership: £20 (concession £10) £ 5 year membership £70 (concession £35) £ Donation To UKIP (optional) : £ Total cheque enclosed £ (please make cheque payable to "UK Independence Party") and post to : UK Independence Party Hamilton House Lyne Surrey KT16 0AN 01932-873557 Please indicate how you wish to help UKIP in the future: -- standing as a candidate . -- assisting in campaigns/leafleting . -- donating by standing order . -- displaying a garden poster . .

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