Surrey Coalition of Disabled People

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Joining form

We’re delighted that you’d like to join us and we look forward to welcoming you.

By completing this form, you can join any (or all!) of the following areas of our work:

  • Become a member of Surrey Coalition of Disabled People
  • Register your interest in our Tech to Community Connect service
  • Register your interest in our Independent Mental Health Network.

Please complete the sections for the particular area(s) that you are interested in.

Section 1. Information about you

Preferred means of contact
Disability

Section 2: Which Networks would you like to join? Please tick all that apply:

Surrey Coalition of Disabled people (please also complete sections 3 and 6)
Tech to Community Connect
Independent Mental Health Network (IMHN)

Section 3 Membership of Surrey Coalition of Disabled People

Please only complete this section if you would like to join the Coalition.

As a Coalition member, you will become a part of the Disability Empowerment Network in your area (North Surrey, Mid Surrey, South West Surrey or East Surrey). Attending the meetings is not compulsory, but we would love to hear your views!

Please tick those you wish to receive information about

Groups you would like to join (please tick those you’d like to receive information about):

Information you would like to receive
If you would like to receive the quarterly Coalition Newsletter, what format would you like to receive it in?

Section 4: Membership of Tech to Community Connect

Please only complete this section if you would like to use the Tech to Community Connect service.

Section 5: Membership of the Independent Mental Health Network

Please only complete this section if you would like to join the Independent Mental Health Network.

Section 6: Consent and Data Protection

In order to join the networks you have chosen, we need your permission to keep and use the information you give us about yourself. Please read and complete this section.

When you sign (or submit electronically) this form, you are giving your consent to become a member of the networks run by Surrey Coalition of Disabled People which you have ticked on this form. Surrey Coalition will store and process the information provided on this form and any other information you might subsequently provide to administer your membership. We are committed to keeping information about you secure and confidential. You can find out more about how we do this in our Privacy Policy.

For members of Surrey Coalition of Disabled People:

If you have chosen to become a member of Surrey Coalition of Disabled People, please note that your liability is limited to a maximum of £1. This means that in the unlikely event of Surrey Coalition of Disabled People going into liquidation, the maximum that you may have to pay towards the organisation’s liabilities is £1 only.

For members of Tech to Community Connect:

I understand that Surrey Coalition of Disabled People will share limited details such as my telephone number and address with Surrey County Council to co-ordinate Tech Angel support visits with me.

I confirm I have read, understood and agree with the statements above and I consent for Surrey Coalition of Disabled People to store and use my personal data to administer my membership of the networks I have chosen, including sending me information that might be of interest to me.


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