National Community Safety Network

Membership Application Form




Your Organisation

Organisation Name

Type

Address
Town
County
Country
PostCode

Region

Your Contact Details

Name

Job Title

Telephone

Fax

Mobile

Password

(for future access to our members area)

confirm

Specific areas of Interest
(please tick those describing your primary interests)

	Alcohol related offending		All

	Anti-social behaviour		Arson

	Asylum skrs/illeg immig		CCTV

	Com partcipation		Com/Neigh/Street wardens

	Commercial crime		Consultation

	Cycle crime		Distraction burglary

	Domestic burglary		Domestic Violence

	Drug Related Offending		Homophobic Crime

	Impact of crime on health		Internet safety

	Performance assessment		Physical crime prevention

	Positive Parenting		Problem solving

	Prostitution		Racial crime

	Reassurance agenda		Regeneration

	Retail Crime		Rural crime

	Terrorism		Transport crime

	Urban crime		Vehicle crime

	Violent crime		Youth crime

	Youth related crime

Membership

Membership Type

If you have a Purchase Order Number please enter it here

Otherwise please provide us with the name of the person who will be managing payment for you here

tick this box to pay online via PayPal

Where did you hear about the Network

If Other please state

How would you like us to communicate with you as a member?

by post by email both

An invoice for your first year of membership will be sent to you on receipt of this Application for Membership Form.

I agree to clause 7 of the Memorandum of Association of this organisation.
This refers to your guarantee in the event of dissolution. For details of our Memorandum of Association please visit the 'About Us' section of this website.

The information on this form will be held on a computer database.
If you have any objection to this please check here
This information will not be passed to any third parties without consent.

I agree/ do not agree (*please check as applicable) to allow my details given above to appear into a Members' Directory and in the Members Area of the NCSN Website (for password controlled access by Members only).




< back		Please note that approval of all applications for membership will be at the discretion of the National Executive Council