OPTIONAL Name of building :
In a block of flats (Example : Saint George's House) OR a small named building that has no number (Example : Sunny Cottage)
OPTIONAL : If you live in a district.
If you are new to the party, you may also want to order an infopack.
An activist pack contains :
* 200 leaflets, please distribute them.
* ReferendumNow petitions - please get your family, friends and workmates to sign them.
* 5 Voice of Freedom newspapers. Please sell them and post back a cheque for £3.75 (The price of 5 Voice of Freedom's).
Please state how far you can drive in miles.
If you have a decent broadband connection at home, that is good enough for voice use (Skype, MSN, Yahoo), please check "Yes".
To cover costs for the activist pack, please debit my credit / debit card to the amount of £4.83
Some debit cards have an issue number. If yours does, enter it here.
The start date of your card (if applicable) in "MMYY" format.
Enter the card expiry date in "MMYY" format.
Your security code is normally a 3 digit number on the far right of the signature strip on the back of your card. In the case of Amex your security code is 4 digits normally on the front of the card.