Membership
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Associate Membership online application form
Name of individual nominated to receive the hard copy of the monthly newsletter:
Position held:
Project/Service:
Address:
Postcode:
Borough:
Switchboard number:
Personal line number:
Fax:
Organisation email:
Individual email:
Are you part of a larger organisation (i.e. more than one site/ one project)?
No
Yes
Is your site the headquarters of your organisation?
No
Yes
Name of main organisation:
Is it:
Statutory
Voluntary
Private
Names and emails of other Newsletter recipients
(e.g. Joe Smith, joe@smith.co.uk):
Associate membership fee bands (please indicate most relevant):
Individual (£50.00)
Organisation (£400.00)
Individual Service User (£ on application)
Service User Organisation (£ on application)
Outside London Individual (£50)
Outside London Organisation (£200)
An invoice will be sent to the address supplied.
