Level Playing Field Membership Form 2015/16 – National Governing Body Membership 1. Organisation Details Name of organisation: Address Contact Primary contact Other Name Telephone Email 2. Membership *Full or Associate membership? Is your organisation 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). 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 P a g e 1 of 2 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. P a g e 2 of 2