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Membership Form

Only fields marked with an asterix are required for registration, but filling out the rest of the form will help us cater for you better.

Individual Details:

Step 1

Please provide your personal details.

Title
First name*
Last name*
Ethnic Origin
Date of birth
Gender

Postal Address:

Step 2

So we can contact you please provide your contact details.
Preferred Contact Method
e-Mail*
House Number
Street Name
Town/City
County
Post Code
Telephone
Mobile no
Fax no

Login details:

Step 3

You need to think up a username and password for yourself. This will enable you to access further areas on our web site (password can be changed later). Your username must be at least 6 characters long with no spaces.

Username*
Password*
Re-type*

Statutory Sector:

Step 4

Do you work in the Statutory Sector?	Yes No
Which Statutory sector group?
What is your role?

Family Carers:

Step 5

Are you a family Carer?	Yes No
Who do you care for?
What relationship are they to you

Categories:

Step 6

Choose the areas you are interested in from the list below.


Advice and information	Select all
Advice and information	Advocacy
Animal Welfare	Arts, Media and culture
Campaigning	Charity Shop
Community centre / village hall	Community development & community planning
Community safety / criminal justice	Economic development (including regeneration and employment)
Education & training	Emotional support (e.g. befriending, counselling bereavement support etc)
Environment and conservation	Faith Groups
Financial services (inc Credit Union)	Funding advice
Grant making trust	Health
Heritage	Housing & hostels
International development	Mediation and brokerage
Places of worship	Play / Youth work
Research and development	Social care and welfare
Social Clubs	Sport & recreation
Translation service	Transport
Uniformed group	Volunteering

Client Groups	Select all
Children & Young People (age 5-13)	All members of the community
Animals	Black and ethnic minority people
Carers	Children & Young People (age 14-19)
Children (under 5)	Drug, alcohol and substance users
Families and Parents	Gypsies and travellers
Homeless people	Lesbian, Gay, Bi-sexual and Transgender people
Men only	Offenders, ex- offenders, those at risk of offending
Older People (age 50 +)	People of a particular religion, faith or culture
People with a learning disability	People with a medical condition
People with a physical disability	People with a sensory disability
People with a terminal illness	People with mental health issues
Refugees and asylum seekers	Service and ex-service people
The environment	Unemployed people
Victims of crime, violence or abuse	Voluntary organisations and community groups
Women only	Young People (20-25)

Join:

Step 7

I accept the

Only click this button ONCE --><--Only click this button ONCE

By clicking on the 'Sign Me Up' button you are agreeing to our Terms & Conditions.