APPLICATION FORM CAMPAIGN DONATIONS FOR LOCAL ELECTION CANDIDATES 2014 Name: _____________________________________________________________________ Address: ___________________________________________________________________ Local Electoral Area: _________________________________________________________
Reason for funds:
Amount Sought: _____________________________________________________________
Pledge I, the undersigned, pledge to use any funds received from Labour Women in pursuit of my local election campaign 2014 as a candidate for the Labour Party. If I resign my membership of the Labour Party before the 23rd May 2014, I commit to returning any funds received from Labour Women to the Labour Women Executive within four weeks of the date of my resignation. Signed: ____________________________________________________________________ Date: ______________________________________________________________________ Labour Women 17 Ely Place, Dublin 2 P: 01 – 678 4712 E: women@labour.ie