Membership Application Form

Address:

Email:
example@example.com
Phone Number:
Website:
2) Contact Details
Name:

First Name Last Name
Job Title:
Email:
example@example.com
Phone Number:
3) Organisation/Company Description
Please give a brief description of your organisation / company, activities undertaken and your interest in sustainable transport:
4) Membership Categories and Fees:

(please tick one category only) Please do not enclose payment at this stage. You will be invoiced once your application has been approved.
Public Sector

£250 -- Public Bodies (other than Local Authorities) £750 -- Local Authorities with a population less than 175,000 £2,000 -- Local Authorities with a population of 175,000 – 500,000
Private Sector

£50 -- Sole traders £100 -- Companies with turnover less than £500,000 £500 -- Companies with turnover £500,000 - £10m £750 -- Companies with turnover £10m - £50m £1000 -- Companies with turnover £50m - £100m £2000 -- Companies with turnover £100m and over
Voluntary Sector

£30 -- Unstaffed / voluntarily staffed organisations £60 -- Organisations with less than 10 paid staff £250 -- Organisations with 10 – 250 staff £600 -- Organisations with over 250 staff
Should be Empty:

1) Organisation/Company Details