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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
Organisation name

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.1


Type of Service	Select all
Abuse	Animal Welfare
Arts & Culture	Bearevement Services
Capacity Building & Service to other organisations	Conflict Resolution
Crime & Safer Communities	Domestic Violence
Education & Training	Employment
Environment & Sustainability	Equality & Access
Funding & Finance	Health & Social Care / Community Care
Heritage	HIV / AIDS
Housing / Homelessness	Immigration
IT, Computers	Law & Rights
Leisure, Sport, Healthy Living	Lifelong Learning
Neighbourly Care	News, Media
Parks, Open Spaces	Regeneration & Community Development
Rehabilitation	Self-help
Susbstance Misuse	Transport
Type of Service	Volunteering
Welfare Rights
Service Delivery Method	Select all
Advice	Advocacy
Befriending	Broadcasting
Campaigning / Awareness Raising	Charity Shop
Consultancy	Couselling / One to One Support
Equipment Hire / Supply	Events / Outings
Home Visits	Housing
Information	Liaison
Marketing	Media
Mediation	Meetings
Mentoring	Office Based
Research	Signposting
Telephone Helpline	Training
Translation / Interpretation	Transport Provision
Venue Hire	Youth Activities

Client Groups	Select all
Adults (Age 18-25)	Adults (Age 25-50)
Adults (Age 50-65)	Adults (Age 65+)
Asylum Seekers and or Refugees	Basic Skills Needs
Care Leavers	Carers
Children & Young People (Age 0-5)	Children & Young People (Age 13-18)
Children & Young People (Age 5-12)	Disabled People
Economically Disadvantaged	Immigrants
Incest Survivors	Learning Difficulties
Lesbians, Gay, Bisexual, Transgender	Lone Parents
Medical Condition	Men Only
Minority Ethnic Comminity	Other Voluntary Organisations
Parents / Families	Patients
Prisoners and or Ex Offenders	Religious Faith Community
Residents in Deprived Neighbourhoods	Sensory Impairment
Tenants and or Residents	Terminally ill
Travellers	Unemployed
Victims of Crime	Volunteers
Women Only
Geographic Areas Service is Provided	Select all
Cann Hall	Cathall
Chapel End	Chingford Green
Endlebury	Forest
Grove Green	Hale End
Hatch Lane	High Street
Higham Hill	Hoe Street
Larkswood	Lea Bridge
Leyton	Leytonstone
Lloyd Park	St James Street
Valley	Waltham Forest-wide
Wood Street

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.

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