Fields marked (*) are required

Name:

Organisation (if appropriate):

Address:

Postcode:

Email address:*

Telephone Number:

Membership Category (please tick one)

 Individual

 Community Building/Village Hall:

 Voluntary/Community Organisation (Annual income under £10,000):

 Voluntary/Community Organisation (Annual income over £10,000):

 Public Sector Organisation:

 Commercial Organisation:

 Parish Councils (dependent on size):

Data Protection Statement

The information on this form may be held by us at The Community Council of Shropshire for sending out information to you.

Occasionally other voluntary and community organisations may wish to contact you. If you are happy for us to share your details with these organisations please tick here: