CVS Brent - Membership Registration
Welcome to the membership form for CVS Brent!

This form is for organisations and groups wishing to register or renew their membership of CVS Brent. Membership is free and this form will only take a few minutes to complete. If you have any difficulty completing this form, please contact or call 020 3011 1690.

Geographic Eligibility
To be eligible for membership, your organisation MUST
* be based in Brent
* or be operating in Brent
Is your organisation based in Brent? *
Does your organisation operate in Brent? *
Organisation Name
Organisation name *
Please enter the full name of your organisation.
Your answer
Any other commonly used, abbreviated or acronyms for your organisation name
Your answer
Please enter the full postal address of your organisation.
Address line 1 *
Your answer
Address line 2
Your answer
Address line 3
Your answer
Town *
e.g. Wembley
Your answer
e.g. London
Your answer
e.g. Middlesex
Your answer
Postcode *
Full postcode
Your answer
Please fill in the details below for the contact for your organisation for the purpose of this application.
Full name *
Your answer
Position in organisation *
Your answer
Telephone / Mobile number(s) *
Your answer
Email *
Your answer
Description *
Enter a brief description of what your organisation does (approx 100 words)
Your answer
Your answer
Legal status
For more information on the types of legal status, visit
Legal status *
Tick ALL that apply. Please note, private companies limited by shares without community interest company (CIC) status are not eligible for membership.
Registered Charity Number
If your organisation is a Registered Charity, please enter the Registered Charity Number here
Your answer
Company Number
If your organisation is registered with Companies House, please enter the Company Number here
Your answer
Geographic areas of work
Geographic areas of work *
Which areas of Brent do you predominantly operate in? Tick ALL that apply.
Priority themes of work
To help CVS Brent build up an accurate picture of its member organisations, please complete the Priority Areas section as fully as possible by RANKING the priority themes of your organisation's work. This will allow us to compare the areas of support provided by local organisations in Brent against unmet or newly identified needs in the community. The information supplied here can also allow us to identify organisations that potentially could complement each other and undertake partnership work. You must choose at least one priority area.
Priority theme - 1st Highest *
Ensure you choose a DIFFERENT option across your ranks of priorities
Priority theme - 2nd
Ensure you choose a DIFFERENT option across your ranks of priorities
Priority theme - 3rd
Ensure you choose a DIFFERENT option across your ranks of priorities
Priority theme - 4th
Ensure you choose a DIFFERENT option across your ranks of priorities
Priority theme - 5th
Ensure you choose a DIFFERENT option across your ranks of priorities
If other priority themes
If you cannot select from the given themes, then please suggest other broad theme area(s) here.
Your answer
Funding received
Funding *
Please indicate how much funding you received in the last/current year. This includes funding from non-statutory grant giving bodies e.g. Big Lottery, Comic Relief and from statutory sources e.g. Brent Council, Brent CCG.
Newsletter Subscription *
We recommend that you subscribe to our Newsletters & Updates. Newsletters are monthly and other updates and communications are sent more sparingly for pressing matters. Tick the box to subscribe.
Declaration *
Please tick to confirm that you understand and agree with the below statement on behalf of your organisation:
Press the SUBMIT button below
Thank you for taking the time to complete our Membership Form. Your details will be held securely. If you have any additional enquiries, please contact

Click SUBMIT to complete your Membership Form.

Never submit passwords through Google Forms.
This form was created inside of CVS Brent. Report Abuse - Terms of Service