Special Interest Group for Homelessness

Membership Application Form

Please provide the following contact information:

*First name

*Last name

*Title

*Occupation

*Work Address

 
 
 

*Postal code

*Work Phone

Fax

*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 £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
Nottingham
NG3 4EY

Tel: 0115 844 0083

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