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

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Post Code   ................................   Telephone Number..................................

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

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

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

Small donations are very welcome but only if these can be afforded.

http://www.unileverpensioners.org.uk