Application Form

Associate Membership – £80.00 p.a.

By completing this form, if your application is accepted you agree to abide by the Association’s Conditions of Membership.

Name of Company*

Business Address

Business Telephone Number

Business Email Address*

Contact Email Address (if different)

Website Address

Type of Organisation

Name of Proprietor(s)*

Address of Each Proprietor

Name of Manager (if different)*

Contact Details of Manager*

Any other care related businesses owned e.g. Supported Living / Dom. Care Agencies / Care Home etc.*

We agree that SECHA may share our data with other companies with whom SECHA have a business relationship or are sponsors of SECHA.

Signed*

Date

Please tick the box below to confirm you are human*

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