Special Interest Group For Community Development

Membership Application Form

Please provide the following contact information:

*First name

*Last name

*Title

*Occupation

*Work Address

 
 
 

*Postal code

*Work Phone

Fax

*Work E-mail

*Home Address

 
 

*Postal code

* Home E-mail

Fax

*Home Phone

   

*Membership No.

   

*Employing Trust/Authority .

*Any Previous Relevant Experience.

*Special Interests Relevant to the Group.

   

*Are you prepared to be contacted for your opinion in relation to your experience and interests?

   

*Are you prepared to be read and comment on documents in relation to your experience and interests?

   

*Can this form be held on the Committee Representative home computer for use by the SIG for Homelessness and the CPHVA?

*Date

Subscription fee is £10 for a year from October 2001

Make cheques payable to: SIG for Community Development

Please complete this form and forward with payment to:

Ms Marion Hamilon
29, Treseder Way, Cardiff, CF5

Tel. 02920 255 409

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