Level Playing Field Membership Form 2015/16 – Individual Membership
1. Personal Details
Name:
Telephone:
Address:
Club(s)
supported:
2. Membership
*Full or Associate membership?
Are you a new or returning member?
How did you find out about LPF membership?
*Full = Paid membership with voting rights at annual LPF AGM.
Associate = Free membership with no voting rights at annual LPF AGM.
3. Payment
Methods of payment:
BACS payment (preferred): Bank: Cooperative Bank, Sort Code: 080228, Account Number: 65682476
Reference: Please clearly state your name and that the payment is for ‘LPF Membership’.
Cheque: Please make cheques payable to Level Playing Field. Please clearly put your name and ‘LPF
Membership’ on the back of the cheque as a reference.
Just Giving: Electronic payments can be made via www.justgiving.com/levelplayingfield (please clearly state
your name and that the donation is for ‘LPF Membership’ in the comments box).
*LPF offers a concessionary rate of membership (£5 per individual) to individuals who are either full-time
students, of pension age, claiming benefits or on a low income. For more information on concessionary
membership please call us on 0208 621 2403 or email us at info@levelplayingfield.org.uk.
Amount paid:
Donation?
Method of payment:
Gift Aid?*
*You can make your membership/donation worth more by using Gift Aid. For every pound you donate with Gift
Aid, we can claim an extra 25 pence from the Inland Revenue. For more information click here
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4. Forms
Please return your completed membership form to info@levelplayingfield.org.uk or by post to the following
address:
Level Playing Field
c/o CAFE
1 Olympic Way
Wembley
HA9 0NP
5. Checklist
Have you completed the form in full? ☐
Have you included a clear reference with your payment? ☐
Have you completed the Equality Monitoring Form? ☐
6. Declaration
By joining Level Playing Field you are agreeing to follow the LPF Guiding Principles. For more information click
here www.levelplayingfield.org.uk/guiding-principles
Signed:
Dated:
An electronic signature is acceptable if returning your form via email.
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