Join C.A.N.

Please print off this form, complete it, and post it (with your donation) to C.A.N.

There is no formal membership fee to join the Countryside Action Network.  We ask you to make an annual voluntary donation, and the suggested minimum is £5.00.  If you can afford a little more, that will obviously be a great help, as no organisation can run on enthusiasm alone!  Please make your cheque payable to Countryside Action Network.  (We will also happily accept unused first class stamps!)

TITLE & FIRST NAME:
SURNAME
HOUSE/FARM NAME:
NUMBER/STREET
VILLAGE/ TOWN: 
COUNTY:  POSTCODE: 
TELEPHONE (HOME):  TELEPHONE (WORK):
FAX:  MOBILE: 
Email:Do you have access to the Internet?: 
BEST MEANS & TIME TO CONTACT: 
RESOURCES AVAILABLE e.g. HORSEBOXES / TRAILERS / TRACTORS / OTHER: 
PERSONAL RESOURCES/SKILLS e.g. DATA PROCESSING / PRINTING / POSTER / PLACARD / BANNER PRODUCTION / SUPPLY.

 

 
RURAL INTERESTS: 
HUNT/CLUB (If Any): 
REFERENCE:e.g. club secretary, shoot captain, hunt master, huntsman, gamekeeper: 
THEIR TEL:
VOLUNTARY ANNUAL DONATION ENCLOSED £

I confirm that my details may be held as considered appropriate, on the understanding that they will not be divulged to any other organisation. 

SIGNED:

 



Countryside Action Network
P.O. BOX 22, USK, NP15 1ZA


e-mail: info@countrysideaction.net