APPLICATION FORM

Protect YOUR Pension
JOIN US TODAY

    If you wish to join us, please print this page, complete the form and post it to:

    Hon. Secretary, COUP
    20, Nursery Close,
    Shirley,
    CROYDON, CR0 5EU

    YES, I want to confirm my support for COUP

    Title (Mr/Mrs/Miss) ...................................

    Initials or first name ................................................  Last Name .......................................................

    Address  ......................................................................................................................................

    ...................................................................................................................................................

    ...................................................................................................................................................

    Post Code   ........................................   Tel No.  .............................................................................

    E-mail address .........................................................................................................

    Pensioner/Spouse's Former Company ...................................................................................

    Signature ........................................ Date .................................................

      There is no membership fee but if you are able to make a small donation it will help towards our expenses. Please make cheques or postal orders payable to "COUP"

      My cheque/Postal Order for £ .................... is enclosed herewith.

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    http://www.unileverpensioners.org.uk