Membership Application and Renewal Form Unique IDOrganisation detailsName of organisation applying for membership(Required) Address(Required) Street Address Address Line 2 City Post code Website (if applicable) Type of organisation Private Sector Charity registered in England and Wales Charity registered in Scotland Charity registered in Northern Ireland Co-operative and Community Benefit Society CIC / Social Enterprise Local Authority / Housing Association / Health Authority Citizens Advice / Consumer / Regulatory Other Charity registration number Private Sector Energy Supplier Retail Manufacturer Installer Consultant Please confirm your annual turnover is less than £500,000 I confirm my annual turnover is less than £500,000 Select the nation/region your organisation is based in(Required)SELECTEngland – NORTH EASTEngland – NORTH WESTEngland – YORKSHIRE & HUMBEREngland – EASTERN REGIONEngland – EAST MIDLANDSEngland – WEST MIDLANDSEngland – SOUTH WESTEngland – LONDONEngland – SOUTH EASTNORTHERN IRELANDSCOTLANDWALESMembership primary contactMembership covers the whole company/organisation. Please give a primary contact; you can add additional people who wish to be added to the membership mailing list below.Your Name(Required) First Last Job Title Your email address(Required) Enter Email Confirm Email Additional contactsGive details of any additional people you would like to receive membership mailingsClick + to add more rowsNameJob TitleEmail address Add RemoveTerms and conditions of membershipBy applying for membership you agree that: – You are applying on behalf of your organisation/authority and not in a personal capacity and you have the authorisation to do so. – You agree that NEA can refer to your company/authority as an NEA member, and may use the company/authority logo on the members pages of the NEA website. – Your organisation/authority supports the objectives of NEA. – Members should behave in a way which maintains the professional standards associated with the membership of NEA as a national charity. – Membership of NEA does not provide an endorsement of technical or other standards and should not imply that it does. – Members may only use or reproduce NEA’s logo with the written permission from the organisation. – Reference to membership may be included on letterheads used for individual correspondence. Agreement(Required) I agree to the terms and conditions outlined above Consent(Required)I understand that my details will be added to NEA’s membership database and used to contact me with membership-related information, including newsletters. I understand that my information will not be passed to any third party unless permission is given. I agree to the privacy policy.Membership type and paymentSupporting Membership is FREE and is open to charities, Community Interest Companies, local authorities, Citizens Advice and not-for-profit registered housing providers. Supporting Membership does not include discounts on training courses or conference delegate places. Enhanced Membership (Community) is open to the above categories and includes all benefits. Enhanced Membership (SME) is open to private sector small to medium businesses with a turnover of less than £500k and includes all benefits.Which membership category are you applying for?(Required) Supporting Membership Enhanced Membership (Community) Enhanced Membership (SME) How do you wish to pay?(Required) Please invoice me Credit/debit card Purchase Order Number Address for invoice/VAT receipt Tick if same as above Enter if different from above Street Address Address Line 2 City Post Code Email address to send invoice/VAT receipt (if applying for Enhanced membership)(Required) Enter Email Confirm Email Which month would you like your membership to start?(Required)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberMembership fee (community)(Required) Community: Enhanced Membership (Eng/Wal/Sco) – £75 + VAT Community: Enhanced Membership (Northern Ireland) – £50 + VAT Membership fee (private sector)(Required) Private Sector: Enhanced Membership (Eng/Wal/Sco) £300 + VAT Private Sector: Enhanced Membership (Northern Ireland) – £180 + VAT VAT @ 20% Price: £ 0.00 Total Credit CardCard Details Cardholder Name
