JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Green Liberal Democrats Membership Registration
Membership Registration Form for The Green Liberal Democrats
* Indicates required question
Email
*
Your email
Name
*
Your answer
Liberal Democrats Membership Number
Required for full membership. If you have any other party allegiance it must be declared.
Your answer
Mobile
Your answer
NUS number or UB40 reference
Required only if claiming the concessionary rate when between the ages of 25
and 65
Your answer
Optional Communications?
We will contact you about your membership and for General Meetings, usually by email. This is required. For other communications, please tick to indicate which methods we MAY use.
Post
Email
Landline
Mobile (including SMS/text)
Data Permission
*
By completing this form you affirm that the data given above is correct at the time of writing and give permission for it to be entered onto the GLD membership database and used as per their data use guidelines published online at:
https://greenlibdems.org.uk/en/page/membership-faq
I grant permission for the data on this form to be used as detailed.
Required
I have payed the Green Liberal Democrats (per annum)
£30 (councillor or key activist)
£20
£13 (concession)
Clear selection
If you are a Councillor or Key Activist please specify role
Your answer
Do you have any particular interest or expertise on environmentalism that could benefit the GLD or other members?
Your answer
Would you like to volunteer for the Green Liberal Democrats committee?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
