CPRE Herefordshire Membership: please print out this form and post it to

CPRE, FREEPOST SW3524, London SW1W 0BR (Postage is free if sent within the UK.)

I would like to help CPRE defend the Herefordshire countryside

Name: _______________________________________

Address: _______________________________________ _______________________________________

Postcode: _______________

Tel no: _______________________________

E-mail: _______________________________

I wish to join CPRE Herefordshire Branch. Please enrol me as below: (Please tick as appropriate)

Individual	£20.00	[ ]
Joint	£27.00	[ ]
Under 25	£12.50	[ ]
Family Membership	£33.00	[ ]
Local Groups	£25.00	[ ]
Concessionary (for applicants living solely off the state pension, unemployment benefit or social security)	£10.00	[ ]

I enclose a cheque/PO made payable to CPRE
I wish to pay by Mastercard / Visa / American Express / CAF Charity Card / Switch Card No. _______________________________ Card Expiry Date ____/_____ Start Date (Switch) ____/____ Issue Number (Switch) _________________

Signature ____________________________________ Date _________________

I would prefer to support the work of CPRE in Herefordshire financially and enclose a cheque made payable to CPRE Herefordshire for £ ______________ (many thanks).

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

Campaign to Protect Rural England, Herefordshire Branch (Registered Charity no 213951)

HF01C/B/BL/2002

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