Request edit access
Pro-Action Membership Alliance Application 2021-2022
All Organisations must complete this application to become part of the Pro-Action Membership Alliance.
Membership Commences 01/09/2021 until 31/08/2022 and includes multiple site locations within your organisation - 1 membership, multiple sites.
Sign in to Google to save your progress. Learn more
1.  What is the name of your organisation? *
2. If you know and already have a Unique Membership Number- please let us know below. It will start with PA.............
3. How would you describe your organisation? *
4. What district/s does your Organisation operate in? *
Required
5. Organisation Membership - unlimited sites.                                                                                                 Please provide your operating address below (if you have more than one, please list each separately). *
6. Organisation Operating address if different from registered address
7. Please provide the name of your main contact person: *
8. Please provide their telephone number: *
9. Please provide their email address: *
10. Who should we contact for bills/payments?  If different from above, please provide their name, telephone number and email address. *
11. What age group does your Organisation support? Please tick all that apply. *
Required
12. How many children/young people attend your Organisation in an average session?  Please select 1 option only. *
Required
Privacy Statement.
Under Data Protection Regulations, Pro-Action is required to ask you to give us permission to contact you.  As you have chosen to use our Membership Alliance services, we will send you information about our activities, by post, telephone, email, SMS, and various social media platforms.  
This statement, sets out the agreement we make with you about how the information we hold is used, stored and shared (if relevant).

We will retain the following information and use it in the following way:

• Organisation, main contact and billing details - to be used for professional purposes only in relation to Membership Alliance services (not shared with third parties).
• Payment details in relation to Membership Alliance services i.e: bookings, bank and card transactions data is not retained by Pro-Action.
• Training Participants name, address, telephone/mobile, email and payment details are retained – to be used for participant course information, distributing certificates and maintaining a training record.  
• No applicant details are held by Pro-Action in relation to DBS checks carried out through online service providers.

Data Storage & Retention:
• We hold the information identified on a secure database with restricted password protected access.  
• This information will be held for the duration of your Pro-Action Membership Alliance and for one calendar year thereafter.

The Information Commissioner’s Office is the regulatory authority.  If you are unhappy about how your data is being kept/used, you have the right to make a complaint to them.

Your Declaration:
• I understand that Pro-Action will only use the information I have provided in relation to our Membership Alliance and the services provided.
• I understand that Pro-Action will not share my information with any third-party organisation, limited to but with the exception of Safeguarding/ medical emergency/ contractual obligations.
• I understand that this agreement will remain in place for the duration of our Pro-Action Membership Alliance and for one calendar year thereafter.
• If I need any further information, I will contact Pro-Action's Data Protection Officer, Tracy Wilkins.
                             
 
13. Please write your name, the name of your Organisation and today's date to indicate that you have read, understood and accept the Privacy Statement as outlined:   *
14. So that we can promote you, please share with us your Facebook link:
15. Please share with us, your Twitter link:
16. Please share with us, your Instagram link:
17. Is there anything else you want to share with us?
18. Is there anything we can do to help you right now?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms