FAMILY GROUP CONFERENCE NETWORK MEMBERSHIP SIGN UP FORM Family Group Conference Network sign up form DETAILS FOR FAMILY RIGHTS GROUP WEBSITE Project name Please type your full name. Organisation Please type your full name. Name of contact(*) Please type your full name. Address 1(*) Please type your full name. Address 2 Please type your full name. Address 3 Please type your full name. Town(*) Please type your full name. Post Code Invalid Input Telephone E-mail(*) Invalid email address. For office use only and will not be displayed on our website What type of organisation does your project fall under? Statutory organisationVoluntary organisationOtherInvalid Input If other, please specify what type of organisation your project falls under Invalid Input What types of work is your project involved in? Youth JusticeChild WelfareEducationOtherInvalid Input Please specify what other types of work your project is involved in Invalid Input What services do you provide? AdvocacyService Users ForumOtherInvalid Input Please specify the other types of services your project provides Invalid Input Does your project have independent evaluation? YesNoInvalid Input FOR OFFICE USE ONLY Please select the FGC Membership you'd like to purchase(*) Family MemberSelf-employed Co-ordinatorsSmall Group MembershipMedium Group MembershipLarge Group MembershipUnwagedInvalid Input Method of payment Please select one:Online paymentInvoiceInvalid Input Do you require a purchase order number for payment?(*) YesNoInvalid Input If your employer requires a purchase order number for payment please include here (for invoice) Invalid Input How would you like to receive your billing invoice?(*) EmailE-portalPosted to billing addressInvalid Input Please specify e-portal information (for invoice) Invalid Input Please specify billing address (for invoice) Invalid Input Billing address Email Billing Telephone FGC Network membership payment online inclusive of VAT Self Employed Co-ordinators Membership - 60.00 GBPSmall Group Membership - 240.00 GBPMedium Group Membership - 420.00 GBPLarge Group Membership - 600.00 GBPUnwaged Membership - 12.00 GBPPlease choose payment amount Total: 0.00 GBP Please note: if you choose to pay online, your booking is not complete until you make payment on the next page. Confirmation of registration Invalid Input This question is a means of preventing automated form submissions by spambots.