Membership Application Form

About You...

Name:

Address:

Email Address:

Would you like us to use this for future communications as it saves us postage?  Yes/No

Telephone:

Are you applying to be a member/associate or representative of an organisation:

(please note full members must be people with disabilities)

If you are applying as a rep, which organisation do you represent?

Your enabling needs...

Will you need transport to meetings?  Yes/No

Do you need assistance at meetings? Yes/No

If so, what?

Do you need sign language interpretation?  Yes/No

Do you need documents in large print, tape or braile?

Please complete and send to:

    Penny Goode

    c/o St Bede's

    Beeches Green

    Stroud

    Gloucestershire

    GL5 4BH