Name: ___________________________________________________

            ____________________________________________________

Address: __________________________________________________

Phone: ___]____________            Mobile: ____]____________

Email:  __________________________________________

 

Membership: $10 00

Donation:      $              

Total              $    _____

 

 þ

Put me on the email list please                                                                      o

Keep me informed about upcoming events please                                        o

I’d like to help organise meetings etc.                                                           o

I’d like information on up coming Brigades to Cuba                                      o

 

Here are contact details for friends who may be interested in joining …

               Name                                                                                     Email Address      

1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
4. ___________________________________________________________________
5. ___________________________________________________________________
6. ___________________________________________________________________                                        

Make cheques payable to Cuba Friendship Society

Email to cusolch@gmail.com

or

Print and mail to:     PO Box 167 Lyttelton 8841