Membership Form
Contact Information:
Name of Organisation*
Name of Chief Officer*
First Name of Key Contact*
Surname of Key Contact*
Email*
Address line 1*
Address line 2
Address line 3
Address line 4
Town*
Postcode*
Local Region* Select Your Region West Somerset Sedgemoor Mendip Taunton Deane South Somerset
Telephone Number*
Mobile Number*
Website*
Date * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
About your organisation:
Does your organisation work on a not-for-profit basis? Select One Yes No
Does your organisation work Nationally? Select One Yes No
Is your organisation party political? Select One Yes No
Is your organisation controlled by local authority? Select One Yes No
Is your organisation controlled by a Somerset based voluntary management committee or board? Select One Yes No
Has your organisation written a constitution? Select One Yes No
Does your organisation operate in Somerset? Select One Yes No
Join SCIPP as a Member:
Does your organisation have a membership of at least ten groups?* Select One Yes No
Does your organisation communicate regularly with members?* Select One Yes No
Do the majority of members of your organisation meet individual organisation criteria as above?* Select One Yes No
Does your organisation have a locally accountable structure?* Select One Yes No
Does your organisation agree to circulate SCIPP information to members and assist SCIPP in involving local groups?* Select One Yes No
Please describe briefly the main aims/activities of your organisation*
Please select which category of membership you think applies to your organisation Select One Members Network Member Affilate Member
If a your organisation is a Network/Forum/Umbrella Organisation:
How many groups are in your network or are members?:
What types of groups are eligible to join?:
Advice and information Select One Interests Expertise Neither
Advocacy Select One Interests Expertise Neither
Arts and Culture Select One Interests Expertise Neither
Black/minority ethnic issues/groups Select One Interests Expertise Neither
Community/voluntary development Select One Interests Expertise Neither
Community development Select One Interests Expertise Neither
Disability issues/groups Select One Interests Expertise Neither
Equality and diversity Select One Interests Expertise Neither
Employment and economic development Select One Interests Expertise Neither
Environmental issues Select One Interests Expertise Neither
Gay, lesbian issues/groups Select One Interests Expertise Neither
Health Select One Interests Expertise Neither
Housing Select One Interests Expertise Neither
Learning difficulties Select One Interests Expertise Neither
Mental health Select One Interests Expertise Neither
Older people Select One Interests Expertise Neither
Partnership working Select One Interests Expertise Neither
Rural development/regeneration Select One Interests Expertise Neither
Skills and learning Select One Interests Expertise Neither
Social enterprise/social economy Select One Interests Expertise Neither
Social welfare/social care Select One Interests Expertise Neither
Sustainable development Select One Interests Expertise Neither
Urban development/ regeneration Select One Interests Expertise Neither
Women’s issues Select One Interests Expertise Neither
Youth issues/young people Select One Interests Expertise Neither
How would you like to receive news from us, by post or mail? * Select One Post Email
At the discretion of the Board we may from time to time make some of this information available to other appropriate organisations. Do you wish us to do this?* Select One Yes No
