Other Disability Groups Application Form Organisation Name (required) Type of Organisation (required) Access GroupCoalition of Disabled PeopleTown CouncilCommunity CouncilCouncilDisability ForumHousing AssociationImpairment Specific Independent Living Service ProviderSocial ServiceOther What geographical area does your organisation cover (eg S Wales, Cardiff etc) (required) Please provide a brief summary of the main aims of your organisation in less than 100 words Your First Name (required) Your Last Name (required) Address Line 1 (required) Address Line 2 (required) Address Line 3 Town (required) County (required) Post Code (required) Tel. Number (required) Voice / Minicom Your Email Website Information Preference EmailPaperBrailleLarge PrintCDAudio Large print font size Δ