Affiliate Membership Form

Affiliate Membership Application Process

PDF

Affiliate Membership Form

Please complete

"*" indicates required fields

Your Organisation

Organisation Name*

Total Annual Budget (capital & revenue)*

Correspondence Address*

Street Address City County Post Code

Facebook

Bluesky

Has your organisation done the following?:

Further information available here: https://www.councils.coop/growing-the-co-op-economy/

Become Fair Tax Accredited

Pay the Living Wage

Lead Contact

Title*

First Name*

Last Name*

Job Title*

Contact Telephone Number*

Email address*

Enter Email Confirm Email

Your Chief Executive/Managing Director

Title*

First Name*

Last Name*

Job Title*

Contact Telephone Number*

Email address*

Enter Email Confirm Email

Twitter

Your Comms/Marketing contact

Title*

First Name*

Last Name*

Job Title*

Contact Telephone Number*

Email address*

Enter Email Confirm Email

Your Invoicing contact

Title*

First Name*

Last Name*

Job Title*

Contact Telephone Number*

Email address*

Enter Email Confirm Email

Our Monthly eNewsletter

We’ll send our monthly eNewsletter to everyone already mentioned. Who else should receive our communications?

Add Recipents

Click the ADD button to include more recipients*

Title

First Name

Last Name

Job Title

Telephone Number

Email Address

Affiliate Membership Form

Affiliate Membership Application Process