Membership Application Form

Membership Application Form
1) Organisation/Company Details
Company/Organisation name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:
example@example.com
Phone Number:
Website:
2) Contact Details
Name:

First NameLast 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
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Membership Application Form

1) Organisation/Company Details

2) Contact Details

3) Organisation/Company Description

4) Membership Categories and Fees: