Affiliate to LCER!
Thank you for affiliating; our affiliated organisations are vital to the success of our campaigns.
The annual affiliation fee is £10 per year, payable by by bank transfer, online with a credit or debit card, or by cheque.
Affiliating organisation
Name of the organisation *
Your answer
Type of organisation *
Are you affiliating for the first time, or renewing? *
Contact details
Please provide a named contact. This would usually be the person filling in this form, but it doesn't have to be.
First name *
Your answer
Last name *
Your answer
Contact person's role within the organisation *
Your answer
Mobile phone number
Your answer
and/or landline
Your answer
Main email address *
This would normally be an organisational email address
Your answer
Alternate email address
We'll only use this if the main email address fails. The best option is to provide the personal email address of the contact person, or another key individual in the organisation.
Your answer
Postal address: street address
Your answer
Town or city
Your answer
Your answer
Resolutions on PR
Has your organisation passed a resolution in favour of proportional representation?
Our website contains ideas for model resolutions - it also contains details about where to send your model resolution once it's been passed.
We'd love to see any resolutions that you have passed
Please paste the text of your resolution here; alternatively you can email it to
Your answer
We accept payment by the following methods:

Please go to our donations page
Enter the contact person's details in the name and email fields, and your organisation's name in the "comment" field.

Our bank account details are: Labour Campaign for Electoral Reform
Co-operative Bank, Sort Code: 08-92-50 Account No. 50013128
Please put your organisation's name as the reference, so we know who the payment came from.

We also accept annual standing orders, paid to the above bank account
Again, please put your organisation's name as the reference, so we can trace the payments back to you.

If you want to pay by cheque, please fill in this form, print it out, and post it, together with your payment, to
LCER, 84 Cranbrook Road, Bristol, BS6 7DB
You may find it easier to fill in a paper form - this is available online at

Please indicate how you intend to pay the affiliation fee. Your affiliation will be active from the date we receive the payment. *
A few final things...
Please confirm that you have read and understood LCER's privacy statement. *
Our privacy statement says that we will keep your data safe. We won't share it with anyone except at your request. You can ask to see the data we hold on you at any time, and ask for it to be amended or deleted. Our full privacy statement is available at
May we include your organisation in published lists of organisations affiliated to LCER?
Any other information about your organisation that may be of interest to LCER?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service