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Membership Application Form

Personal Information

Contact

Telephone

E-mail

Fax

Organisation

Address

Street

Street 2

Town/City

County

Postcode

Website

Please give us a brief overview of the aims of your organisation:

Fee:

Small Organisations
Trade Union Branch 

£67.50

Department within Local Authority

£105.00

Large Organisations
Local Authority
Trade Union Regional/Head Office

£185.00

Sponsor Organisations
(Organisations wishing to support our policy work.)

£405.00

Payment:

Please invoice us

Alternatively you can print the membership application form above, then complete it and return to:

Disability Alliance
Universal House
88-94 Wentworth Street
London
E1 7SA 

or order by telephoning 020 7247 8776

Membership will only be confirmed once payment has been received.

PLEASE NOTE THAT WE ONLY ACCEPT MEMBERSHIP APPLICATIONS FROM ORGANISATIONS, NOT INDIVIDUALS.