CPRE Warwickshire - Application Form

1 [_] Yes, I would like to help CPRE’s work to protect the countryside

Name_____________________________________________________________

Address___________________________________________________________

__________________________________________________________________

Postcode_____________________________Telephone_____________________

E-mail address ______________________________________________________

2 [_] Please enrol me as a member of the CPRE

Minimum Subscription Rates

Individual £31.00*; Joint £40.00*; Family £46.00*; Under 25 £6.00*;
Organisation £34.00*; Parish Council £29.00*;
(* Recommended minimum. If you would like to give further support to our work by
paying a higher subscription, we would be very grateful)
Concessionary £12.00**; Joint Concessionary £18.00**
(** for those living solely on state pension, income support or jobseekers allowance)

If you return this form with payment you will automatically become a member of the
Warwickshire Branch of CPRE (Code 26S)

3 [_] I would like to make a gift of a Donation of [_]£10, [_]£25, [_]£50, [_]£100, [_]£250,
[_]Other amount £____________

Total Amount £__________________ (Thank you)

I enclose my cheque/PO made payable to CPRE

I wish to pay by Access/Visa/Diners Club/CAF Charity Card Card Expiry Date______ /______

Signature______________________ Card No | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ |

Please return your completed form to CPRE Warwickshire Branch,
41A Smith Street, Warwick, CV34 4JA.

NOTE - CPRE and its agencies will hold mailing information on its supporters in order
to keep them informed of its activities. Except in the case of supporters who request
otherwise, selected voluntary organisations may be allowed selected access to such
mailing information for one time only, to enable them to send some details of their services.
Details are held by the Data Protection Registrar.

[ _ ] I do not wish to receive mailings from other selected voluntary organisations.

To find out more about the National organisation of the CPRE, please click here