Membership Form

Contact Name 1

Job Title

Contact Name 2

Job Title

Organisation Name

Email Address

Phone Number

Organisation Address (Number and Street Name)

Organisation Address (Town)

Organisation Address (County)

Organisation Address (Postcode)

Website

Social Media Pages

Best Email for general enquiries

Best Phone Number for general enquiries

What areas does your organisation serve?

Organisation Type

Organisation Description (in no more than 100 words)

How many people benefit from your services? (approx.)

Number of volunteers (approx.)

We’d like to promote your services, what info would you like us to share? e.g. tell us meeting times/dates, meeting place, purpose, any restrictions on who can attend

What is your organisations main area of support?

Would you like to receive any of the following from us?

Derbyshire Voluntary Action bulletin (weekly updates and news which include local activities and support)
Mental Health bulletin (regular updates and news which include local mental health activities and support)
Health & Social Care Voluntary Sector Forum invitations (quarterly gatherings to share best practice, network and learn)
Mental Health Meeting invitations (opportunities to network and hear the mental health updates)
Network Newsletter (stories and updates from our members)
Feeling Connected Bulletin (regular updates on reducing loneliness and isolation across Chesterfield and North East Derbyshire)

Would you like to be added to online directories so that people can contact you for support? (this info will be public on DVA website/Community Directory Derbyshire)

Yes
No

Online directory contact details (if different to contact details above)

I agree to my information being used as set out in the Privacy Policy.

Yes

Please complete the form and click submit at the bottom of the page. Any fields marked with an asterisk (*) are required so please make sure to complete them.

If you would like a physical copy of the Membership form please email us at info@dva.org.uk to request one.

Thank you.