Membership form
Name of organisation: *
Your answer
Contact person: *
Your answer
Position: *
For example Chair, Secretary, CEO etc
Your answer
Organisation or group’s address: *
Your answer
Postcode: *
Your answer
Telephone including area code: *
Your answer
Email address to receive emails for the circulation list: *
Your answer
2nd email address for the list if required: (you can add up to 2 email addresses in the same organisation)
Your answer
Website, if available
Your answer
Part of our membership benefits includes a listing on our website. We only include organisational details (NOT personal contacts). Please select: *
Social media, if available:
Facebook URL:
Your answer
Twitter URL:
Your answer
LinkedIn URL:
Your answer
Type of organisation: *
Number of employees:
Full-time (30 hours or over pw)
Your answer
Part-time (Under 30 hours pw)
Your answer
Volunteers (2 hours or over pw)
Your answer
What type of membership are you applying for? *
How would you like to pay? *
Who is submitting this form? *
Your answer
Submit
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This form was created inside of Bromsgrove and Redditch Network.