Contact sheet for supporters

Name:

I am a supporter of the Campaign.

I believe that the second chamber should be 100%, 80%, 60%, 50%, some other proportion elected (please delete as appropriate)

My contact details are:

Address Email address

Mobile

Member of ………………………………………………………………………… CLP

Position in CLP (if any)

Past council/Parliamentary/European candidate/other position

I have the following comments on the White Paper

I can help the Campaign in the following way(s) eg writing, lobbying, press work. IT, admin

I am available at the following times:

I enclose a donation (payable to Campaign for a Democratic Upper House)

Signature …………………………………………. Date ………………………

Please return to democratic_upper_house@hotmail.com or

CDUH, c/o 47 Lorne Road, London N4 3RU