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Membership Application Form

I wish to apply for membership of Deaf & Hearing Support Company Limited by Guarantee Number 8419437 – Charity Number 1151502

APPLICATION FOR INDIVIDUAL VOTING MEMBERSHIP & APPLICATION FOR ASSOCIATE VOTING MEMBERSHIP

The objects of the Charity (“the Objects”) are to further any charitable purpose for persons with impaired hearing (and/or associated conditions) resident in the North Derbyshire area (“the areas of benefit”) as the Trustees shall from time to time decide with the object that such persons have the highest possible quality of life, independence in daily living activities and full integration into society.

In pursuit of the Objects, the Charity will endeavor to ensure that due care and attention is paid toward ensuring that any services are provided with due regard to the needs of people with sensory impairments regardless of their race, gender, sexual orientation, religious belief, nationality, age or disability.

Rights and Benefits of Membership.
All voting members have the right to attend, speak and vote at General Meetings of the Charity.

Title: First Name: Surname:
Title: First Name: Surname:
Address:  
Post Code: Telephone Number:
Email Address: Would you like to receive the newsletter by e-mail?
Yes:
No:
Date: Textphone Number:
Membership Options Tick the membership you require.
FULL MEMBERSHIP (Voting) £10.00 yearly membership. - £65.00 lifetime membership.
Full individual membership is open to any individual aged 18 years or over, who is interested in promoting the Objects, is hearing impaired and/or has an associated condition and who lives, works or attends an educational establishment within the area of benefit.
ASSOCIATE MEMBERSHIP (Voting) £10.00 yearly membership. - £65.00 lifetime membership.
Associate individual membership is open to any individual aged 18 years and over, who is interested in promoting the Objects, is not hearing impaired or does not have an associated condition and who lives, works or attends an educational establishment within the area of benefit.
COUPLE MEMBERSHIP (Voting) £12.00 yearly per couple. - £75.00 Lifetime Membership.
Agreement for Membership and Guarantee

I/we hereby apply to become a full/associate member of this company limited by guarantee (and registered charity) and agree to be bound by its memorandum and articles of association and any rules made under these. I/we confirm that I support the company’s aims and work. Should the company be wound up, I/we promise to pay the sum of up to £1 towards its debts, if asked to do so, and I/we

understand that this liability will continue for one year after I/we cease to be a member of the company.

Please use the box below to let us know how you became aware of Deaf & Hearing Support:

Applications for membership will be considered by the Charity’s trustees. Membership is terminated if the member gives written notice of resignation, dies, is removed from membership by resolution of the trustees or ceases to comply with the conditions of membership. Membership is not transferable.

Once your application is approved a team member will contact you to discuss payment options. We accept cash or cheque made payable to DEAF AND HEARING SUPPORT.

 

Contact Details

Deaf & Hearing Support (CAMTAD ND)

Resource Centre
Wheatbridge Medical Centre
30 Wheatbridge Road
Chesterfield
S40 2AB

Telephone: 01246 555934
Textphone: 01246 555933

Email: info@deafandhearingsupport.co.uk

Resource Centre Opening Hours: Please contact us to make an appointment

Saturday, Sunday & Monday - Closed / Tuesday to Friday - Open 10am to 12pm & 2pm to 4pm

 

 
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