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Organisation Membership Form

Disability Wales uses email to communicate with our members. Please contact us at membership@disabilitywales.org if you require information to be sent in an alternative format.

Does your organisation qualify for Full Membership?

A Full Member is any organisation actively and legitimately working in Wales which supports the aims and objectives of Disability Wales and whose constitution stipulates that disabled people are in the majority of voting membership by at least:

51% of voting membership AND
51% of management committee or other governing body

Full members:

have voting rights at general meetings
may nominate members to the Board of Directors and participate in any ballot to elect Board members.

If you believe you qualify as a Full Member please supply a copy of your constitution or governing document.

Member Organisation type applying for
Full Member DPOAffiliateSupporter

Organisation Name

Organisation Website/Domain Name

Type of Organisation (please select one)

DPO / Affiliates

Access GroupsCoalitions of Disabled PeopleDisability ForumCommunity of Interest GroupsCentre for Independent LivingHousing Association Disabled People’s GroupSelected in Supporters section

Supporters

Town and Community CouncilsCounty CouncilsHousing AssociationsCharities with >£1m Gross IncomeImpairment Specific Independent Living Service Providers (not for profit)Third Sector Support ServicesTrade UnionProfessional BodiesOtherSelected in DPO/Affiliate section

If other, please describe:

What geographical area does your organisation cover? (Please tick all that apply) *

UK including WalesNorth WalesMid and West WalesSouth Wales

Please provide a brief summary of the main aims of your organisation (max 100 words) *

Please provide a brief summary of the areas we can signpost individuals to you for: *

Organisation Primary Contact Details

Please note: if applying to become a DPO, the primary contact will be the person who can vote at our AGM and be nominated to our board of directors.

Primary Contact Information

First Name *

Last Name *

Organisation Primary Contact E-mail Address *

Organisation Secondary Contact (if applicable)

Secondary Contact Information

First Name

Last Name

Organisation Secondary Contact E-mail Address

Organisation Address

Address Details

Street Address

City

Region / County

Post Code

Telephone Number

Where did you hear about Disability Wales?
Mainstream MediaSocial MediaEventDW ProjectInternet SearchWord of MouthFamily/FriendsOther (please specify)

By submitting your application to become a member you agree to the terms of our
Privacy Policy
which can be found on our website.

Please tick to consent to Disability Wales Anabledd Cymru holding your information on record. Your personal information will not be shared with a third party for any purpose unless your consent is provided first.

Please tick if you would like us to send you information about our services such as news and events.

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