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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
-- Or --
Other ethnic group
Gender

Postal Address:

Step 2

So we can contact you by post please provide your address.
Preferred Contact Method
House/Flat Number
Street
Town/City
County
Post Code

e-Mail & Mobile:

Step 3

To receive important emails and text messages please let us know your details below.

e-Mail*
Telephone (work)
Telephone (home)
Mobile no
Fax no

Categories:

Step 4

Choose the areas you are interested in from the list below.


Advice, Support & Information	Select all
Alcohol/ Drug/ Substance Misuse	Offenders/ Ex Offenders
Citizen' Advice	Benefit/ Debt/ Welfare Rights / Small grants
Funding Advice	Counselling
General Advice	Translation Services
Victims of Crime/ Domestic Violence	Volunteering
Witness Support	Volunteer support
Mediation
Community	Select all
Community development	Crime and Safety
Community Facilities	Media
Community Centres / Village hall	Support for Young People
Faith groups & places of worship	Parish Council
Support for voluntary & community groups	Council For Voluntary Service
Local Strategic Partnership	Parish Planning Group

Health & Social Care	Select all
Caring	Mother and baby
Physical health	Sensory & communication
Parent support	Mental Health
Respite Care	Bereavement Care & Counselling
Hospice / Care Homes	Disability
Patient Involvement in Health	Patients Forum

Economy & Regeneration	Select all
Regeneration	Parish Planning
Agriculture & Food	Charity Shops
Village shops & other Rural retail	Social Enterprise
Broadband and ICT	Business engagement & Corporate Social Responsibility
Business Advice
Education, Work & Training	Select all
Education (children over 16 years of age)	Early Years Education
Learning Disability	Basic Skills
Education years 1-12	Training - IT
Other training	Return to work support
Information Advice & Guidance	Adult education
Lifelong Learning Partnership
Arts, Entertainment, Leisure and Sports	Select all
Creative Arts	Parks & Open Spaces
Sports & Physical Activities	Music & Choral
Social Clubs	Theatre
Dance
Children & Young People	Select all
Child Care	Youth Clubs
Play	Health
Children & Young People Partnership/Trust	Pre-school
Uniformed Youth organisation	Special Needs
Vulnerable children	Child Protection

Housing	Select all
Tenants & Residents Associations	Homelessness
Rural Housing	Sheltered Housing
Housing porvider	Housing policy

Envirnoment / Transport	Select all
Heritage	Conservation
Community Transport	Environment
Local History & Heritage	Volunteer Driver / Cars
Town Twinning
Client groups	Select all
Travellers	Black Minority & Ethnic
Gay / Bisexual / Lesbian / Transgender	Single Parents
People Seeking Asylum	General
Migrant workers	Refugees

Animals	Select all
Animal Rescue	Animal Clubs & Societies
Animal welfare
Older People	Select all
Luncheon Clubs	Friendship Clubs
Good Neighbours Scheme	Health
Advocacy & general support	Day centre

Geographical Areas (By Unitary Council Area)	Select all
Bracknell Forest	Reading
Slough	West Berkshire
Windsor & Maidenhead	Wokingham

Membership details:

Step 5

You need to think up a username and password for yourself. This will enable you to access our web site (password can be changed later). Your username must be at least 6 characters long with no spaces.