NGAG Membership Form

 Newington Green Action Group Membership 

I wish to become a member / I wish to renew my membership (delete as necessary)

of The Newington Green Action Group.

I enclose my annual membership subscription (please tick type)                  2009/10

• Ordinary                        £5.00
• Concession                   £1.00
• Organisation/Business   £10.00
• Donation                       £……..

Name/Organisation     .................................................................................................Mr/Mrs/Ms

 Address                    ..............................................................................................

                                 ..............................................................................................

                                 Postcode............................................Dated............................

 Telephone................................................Email.......................................................

Please send this form, with cheque made payable to The Newington Green Action Group, to:

NGAG Membership Secretary

73 Leconfield Road

LONDON

N5 2RZ                                    

Registered Charity No. 1087866

For further information visit:  www.newingtongreen.org.uk