Arsenal f. C. – Supporters consultative forum application form for groups a-e

ARSENAL F.C. – SUPPORTERS CONSULTATIVE FORUM

APPLICATION FORM FOR GROUPS A-E

I wish to apply to become a representative of the following group:-

	Category	Additional details to complete under “Proof of Category” below	Select ONE category only by placing a cross (X) below
A	Red Member	Membership number
B	Platinum (Club Level) Member	Membership number
C	Executive Box representative	Box number
D	Disabled supporter representative	Membership number
E	Away scheme Member	Membership number

YOU MAY ONLY STAND FOR ONE CATEGORY, AND CAN ONLY RETURN ONE APPLICATION FORM.
Name:
Address:
Post code:
Date of birth: ……………………………………………………………………
Contact telephone number: ……………………………………..………………
Email address……………………………………………………………………
Proof of category (see above) : …………………………………………………

Declaration: I, the above named applicant, confirm that I wish to apply to become a representative on the Supporters Consultative Forum, and that the information provided on this form is accurate.
Signature: Date:

COMPLETED APPLICATIONS MUST ARRIVE WITH ELECTORAL REFORM SERVICES NO LATER THAN 12.00PM ON FRIDAY 21^st MAY 2010.

Postal address: Elliot Roberts, Electoral Reform Services, 33 Clarendon Rd, London N8 0NW

Email address: [e-mail]