Family Group Conference Network Membership Sign Up Form

DETAILS FOR FAMILY RIGHTS GROUP WEBSITE

Project name

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Organisation

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Name of contact(*)

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Address 1(*)

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Address 2

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Address 3

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Town(*)

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Post Code

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Telephone

E-mail(*)

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For office use only and will not be displayed on our website

What type of organisation does your project fall under?

Statutory organisation

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Other

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What types of work is your project involved in?

Youth Justice
Child Welfare
Education
Other
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What services do you provide?

Advocacy
Service Users Forum
Other
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Does your project have independent evaluation?

Yes

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FOR OFFICE USE ONLY

Please select the FGC Membership you'd like to purchase(*)

Family Member (Free - No need to choose Method of payment)

Self-employed Co-ordinators

Small Group Membership

Medium Group Membership

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Unwaged

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Method of payment

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Do you require a purchase order number for payment?(*)

Yes

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If your employer requires a purchase order number for payment please include here (for invoice)

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How would you like to receive your billing invoice?(*)

E-portal

Posted to billing address

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Billing address Email

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FGC Network membership payment online inclusive of VAT

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Confirmation of registration(*)

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