rocc.org.uk Membership Training Consultancy Publications Service Users What's What? ROCC Trading

Application for Membership

Member Details
Name of organisation
Title	Forename	Surname
Position

Organisation Details
Address

City	County	Postcode
Telephone	Ext	Direct No
Fax	Website
Email

Organisation Details
Type of organisation	Reg Charity Private Company Public Body Sole Trader RSL
Number of staff		Part of a larger organisation?
If so, name of organisation

Client Groups
Older People with support needs	Older people with mental health problems	Frail elderly
Mental health problems	Learning disabilities	Alcohol problems
Physical or sensory disability	Single homeless with support needs	Drug problems
Offenders/at risk of offending	Mentally disordered offenders	Young people at risk
Young people leaving care	Women at risk from domestic violence	Refugees
People with HIV/AIDS	Homeless families with support needs	Teenage parents
Rough Sleepers	Travellers
Principle client group (if applicable)

Organisation Description

Please give a brief description of your organisation

ROCC News Subscription

I would like to receive my copy of ROCC membership News by:

Post (1 copy only)	Name of person to receive Address
Email (as many as required)	Email Address

Website Entry

As part of your membership you will receive an entry on the ROCC website, please detail below the information you would like to appear on you entry if different to above.

Address

City	County	Postcode
Telephone
Fax	Website
Email