Special Interest Group for Homelessness

Membership Application Form

Please provide the following contact information:

*First name

*Last name



*Work Address


*Postal code

*Work Phone



*Home Address


*Postal code

*Home E-mail


*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?


Subscription fee is £15 for a year from October 2001

Please make cheques payable to: SIG for Homelessness and post to:

Surviving Homelessness Project
Mellors Lodge, Robin Hood Chase

Tel: 0115 844 0083