Braintree District Voluntary Support Agency

BRAINTREE DISTRICT VOLUNTARY SUPPORT AGENCY

Registered Charity No 147020

Company Limited by Guarantee 7831270

REGISTRATION FORM

Organisation Name:

Registered Charity Y/N

Office or Meeting Venue Address:
Phone:
Email:
Website:

The above information will be put on the Essex Connects Website List of Voluntary and Community Groups

Contact Name:
Position:
Correspondence Address:
Phone:
Email:

This information will be used for BDVSA correspondence purposes only

Description of Organisation:

Services Provided:

Availability: (hours for which organisation & services are available)

Target Group & Eligibility Criteria: (any restrictions that apply)

District covered:

Cost: (any charges made for services)

DATA PROTECTION

I agree that BDVSA may use the information from this form to compile a database and to answer enquiries from the public and statutory sector.

The name of your organisation and a description of its activities will be automatically added to Essex Connects Website. If your organisation does not wish to be listed please tick this box.

Signed:

Name: Date:

Please return to:

Braintree District Voluntary Support Agency

Room 5, Colne House

96 Mount Chambers

Coggeshall Road

Braintree, Essex

CM7 9BY

Tel: 01376 550507 Fax: 01376 550092 Email: