membership form

Please complete the application form below to apply on-line for membership of Shared Care Scotland.

We will send an invoice to you for payment of fees (does not apply to free membership options). Please note that applications cannot be finalised until subscription fees have been received.

Name

Group/Org.

Address

Postcode

Telephone

Fax

Please tick type of membership you wish to apply for.

Individual Membership £12.50

I am in receipt of Income Support and qualify for free membership

Group / Corporate Membership £30.00

I am the named representative of

Respite Forum and qualify for free membership.

Invoice Address (if different from above).

Address

Postcode

Are you (please tick all that apply)

Permanent Carer

Respite Carer

Professional

Other

Caring for / working with (please tick all that apply)

Child / Children

Adults

Elderly Person / People

Please note: Information provided is held on computer to enable Shared Care Scotland to be able to contact you regarding your booking. In addition we may, with your permission, also provide your details to other organisations so they may also keep you advised of events and other services which may be of interest to you. If you wish your details to be passed to other organisations please tick the box on the left.

Send to a friend

If you would like us to send information about Shared Care Scotland to a colleague or friend provide their name and address below.

Name

Address

Postcode

Donation

If you will be making a donation please enter the amount below and send with any due membership fees. Thank you.

Amount