Accountancy Civil Engineer Local Authority Housing Architect Committees Secretarial Building Trade Legal Surveyor Other Please specify:

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1 What Membership is available? LAS membership is available to those who own an ex-local authority property in Southwark. Do you have any knowledge/expertise in any of the following and/or would you be able to help LAS2000 on an ad hoc basis? Accountancy Civil Engineer Local Authority Housing Architect Committees Secretarial Building Trade Legal Surveyor Other Please specify: Please select one option: YES Newsletter, membership card, membership renewal request by POST OR YES Newsletter, confirmation of payment, membership renewal request by MEMBERSHIP APPLICATION AND GUARANTEE FORM LAS2000 has been formed as a company limited by guarantee. The Directors and Board are drawn from the current members. Each member will be one of the members or guarantors of the Company. As a member you will be potentially liable to make a maximum contribution of 1 (one pound) should the company become insolvent. Should you wish to inspect the Memorandum and Articles of Association please contact the Secretary of LAS2000 Please complete the Form below confirming that you wish to be a member. MEMBERSHIP FORM I, the undersigned, hereby apply for admission as a member of LAS2000 ( the Company ). I agree to be bound by the Memorandum and Articles of Association of the Company and by such rules or bye-laws as may be made by the Board and/or Executive Committee of the Company from time to time. I acknowledge that as a member of the Company I may incur liability to contribute to the assets of the Company in the event of its being wound up but that the amount which I may be required to contribute shall not exceed 1. I agree that all notices or other communications from the Company to me may be sent at the option of the Company either to the address specified below or to the address or fax number specified below or to such address or fax number as I may notify to the Company in substitution therefor. Page 1 of 5

2 MEMBERSHIP APPLICATION AND GUARANTEE STATEMENT Title(s): Name (s): Address: Telephone: Mobile: Fax: Date of Birth: Area Forum: DECLARATION I would like to join the Leaseholder Association of Southwark LAS2000 and enclose payment of 15 to cover membership for the current year 2017 (up to 31 March). And for cover membership for year 2018 (up to 31 March) Being Date: Signed: I am Leaseholder / Freeholder please delete as appropriate of an Ex Southwark Council property. I am interested in becoming an active member: Yes / No We would welcome brief details about your interest in Leaseholder issues and any ideas you have for what you feel the priorities for the LAS2000 should be: BEFORE YOU PAY: Please remember to complete the Membership and Data Protection Form. Page 2 of 5

3 DATA PROTECTION Members' personal contacts will be treated as confidential. With members' permission, contacts may be shared amongst members or made public via the website. LAS2000 has a full Data Protection Policy please ask the Membership Secretary if you need a copy or look at our website. The information you provide will not be disclosed, sold or rented to any third party. The you provide is the address that will be used for contacting you directly regarding your membership or other internal business. Your will not be made available to 3rd parties without your consent. YES/ NO I give my consent to my information being held on an electronic and manual database for the purpose of keeping a record of my membership of the LAS2000, in order to provide me with information about LAS2000 activities. From time to time LAS2000 may engage in promoting and public relations YES/NO I give my consent and agreed to my images/words being used in advertising, marketing and promoting public relations in connection with LAS2000 activities and events. LAS2000 also keeps a Members Directory which lists all members names and contact address so that any member can contact you. YES/NO I give LAS2000 permission to show my private address in the passwordprotected Members Directory on the website. If we do not receive your signed form we cannot communicate with you!!! Signed: Dated: Please print your name: Page 3 of 5

4 HOW TO PAY: By Cheque: Made payable to LAS2000 PLEASE SEND YOUR COMPLETED APPLICATION AND PAYMENT TO: LAS William Evans House Bush Road, London SE8 5AU By BACS or Direct payment: BANK: Lloyds Bank Sort Code: Account Number: Please either post or your completed form to contact@las2000.org or LAS William Evans House Bush Road, London SE8 5AU Membership fees: 2017 to 31 st March 2017 is is Also, payable with 2017 membership being due Five Year membership The cost If you wish to pay a for a five-year membership the cost is being a reduction to pa. Page 4 of 5

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