The Jersey Human Rights Group

Membership Application Form

I (name)……………………………………………………………………………Mr/Ms/Miss

Address…………………………………………………………………………………………

…………………………………………………………………..Post Code……………………

Telephone/Personal…………………………………………………………Work………………

Email……………………………………………………………………………………………..

Have read and agree with the aims and objectives of The Jersey Human Rights Group and apply for membership

Am over 16 years of aged Waged/Unwaged

Prefer to receive communications by email/post

Do/do not want to receive copies of regular committee meetings minutes

Subscription – Waged £10.00, Unwaged £5.00

Signed…………………………………………………………Date………………......................

Annual Membership paid where applicable………………………………………………………

2009 2010 2011 2012 2013 2014 2015…………………………………………………………..

The Jersey Human Rights Group Secretary: Nicholas Le Cornu

23 Havre des Pas, Flat 4

St Helier

Jersey JE2 4UQ

Tel: 745573……………………………………………..email:……konarmia@jerseymail.co.uk………………….