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.*

As part of the application form please also complete and return to us the General Data Protection form below. If you do not complete this form we will not be able to communicate with you.

DATA PROTECTION

By signing this form you are confirming that you are consenting to SECHA holding and processing your personal data for the following purposes (please tick all the boxes where you grant consent);

I consent to SECHA contacting me by
PostPhoneEmail

YES to share my contact details with SECHA Members so they can keep me informed about news and events organised by SECHAYES To include my contact details in the SECHA DirectoryYES To share my contact details with other organisations only for the purposes of circulating information on behalf of SECHA

You can withdraw or change your consent at any time by contacting SECHA by telephone on 01268 784501 or by e-mail to; info@secha.org.uk

Please note that all processing of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect personal data that has already been processed prior to this point.

Signed*

Date

Please tick the box below to confirm you are human*