Membership Application

Please fill in the membership Application form below and press send.

Member Details
I am in receipt of Direct Payments/Self Directed Support/other fundingYes
I am the Parent/Guardian working on behalf of a child (16 years or under) in receipt of Direct Payments/Self Directed Support/other fundingYes
I am the nominated agent working on behalf of an Adult in receipt of Direct Payments/Self Directed Support/other fundingYes
I am the Parent/Guardian working on behalf of an Adult in receipt of Direct Payments/Self Directed Support/other fundingYes
I support the aims of SPAEN and wish to join as an Associate member Yes
Organisation Name
Designation
Member Name
Address
Town City
Postcode
Region
Telephone Number
Email Address
Format Details
Font Format
(PLEASE NOTE: On occasion it may not be possible to send information by email. SPAEN will always endeavour to send information in the requested format)
Contact Details *If applicable
Contact Name
Contact Address
Contact Town/City
Contact Postcode
Contact Region
Contact Tel Number
Contact Email
Please Indicate one of the following Membership options
Full SPAEN Membership with Advice and Indemnity and have paid by bank Transfer ( Bank details below )Yes
FULL SPAEN membership with Advice an Indemnity - Please invoice me for £100Yes
ASSOCIATE MembershipYes
Our Bank Details
Account No: 06005251 Sort Code: 80-83-44 Please use your surname as a reference when paying by bank transfer