NAME:
    Surname

 Forename/s

ADDRESS:
 Flat/Building  (e.g. Flat 3, Peabody Towers)

  No. & Street  (e.g. 21 Lower Road)

 Area/District  (e.g. Peckham)

     Town/City  (e.g. Stanmore)

   County/City  (e.g. Surrey or London)

     Post Code

       Country  (e.g. Wales)

PHONE: Daytime   Evening

COMMS: Fax  

    E-Mail

A1. One year's Post Subscription (£3.00 UK, £5.00 Overseas)  £
A2. One year's E-Mail Subscription (£2.00 Worldwide)*        £
B.  "Vegetarian London 2005" (£6.50 post-free for LV Subs.)  £
C.  Donation towards running expenses                        £
 (Please make a note of the total amount payable              -------
      or print the form before submitting)       T O T A L   £
                                                              =======
*E-Mails are sent monthly, but we reserve the right to change to
     quarterly paper mailings and adjust the expiry date accordingly.

Please complete as required:-
  I wish to receive a list of other London Vegan Subscribers
      and permit my name, address and phone number/s to be passed
      on to them.

I would like to help by:-
  Entering Diary Events**,     Writing Publications/Info Sheets,
  Running Information Stalls,  Becoming a telephone contact,
  Speaking in Public,          Giving Cookery Demonstrations,
  Doing Correspondence**,      Doing Mailing/Office Work,
  Doing DIY & Repairs,         Initiating Media Campaigns,
  Other:
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I understand that unless I have ticked the subscribers list box above, none of the information on this form will be passed on to any third parties, and that I may inspect my computer record at no charge (and have it corrected, if necessary) at any reasonable time, subject to adequate notice being given. I will now make an electronic payment from the following screen.

By clicking on  I am agreeing to these terms.

                                                                  [LVFO0111]