Renew or Pay for United Left Membership Join United Left Membership * Ordinary member - £ 20.00 Union officer - £ 50.00 Total Amount Your Registration Info I support the aims of the UL * Yes No Formal Title First Name * Last Name * Gender ID Female Male Other Prefer not to say Do you identify as BAME? Yes No Are you aged 30 years or under? Yes No Email Address (Do not use your work or Unite email) * Street Address Street Address 2 Street Address 3 City Postal Code Region * - select Region - East Midlands Ireland London and Eastern North East, Yorkshire and Humberside. North West Scotland South East South West Wales West Midlands Phone Mobile Phone Current Employer Branch Sector Unite Membership number * Please select as many as are applicable. Unite positions Labour Party Member Unite Delegate to CLP Unite EC Member Regional Committee Regional F&GP Sector RISC Sector NISC Workplace representative Other If you ticked “other” please specify – please separate each position by a comma Brief biography Are you a Unite FTO? Yes No If yes, which office are you based? Can we contact you by email? Yes No Employment status - select Employment status - Employed Unemployed Retired Student Payment Options [x] I will send payment by cash or bank transfer Review your contribution