ANNUAL MEMBERSHIP FORM

Mr Mrs Ms Miss Other

Full Name:

Address:

Post Code:

Home Tel No.:

Mobile Tel No.:

Date of Birth: (optional)

Primary Email:

CP Sport Membership No.: (if known)

I wish to apply for: (please √ appropriate box)

Full Annual Membership – Adult Member (18 yrs and above) £20

Full Annual Membership – Junior Member (under 18 yrs) £15

With this you receive:

  • Discounted entry fees for selected CP Sport events
  • First opportunity on events tickets CP Sport receive from governing body partners
  • Invitation to members meetings and AGM with voting rights for adults
  • Monthly newsletter and CP Sport updates (email required).

Please confirm email address for newsletter...... ………………………………

How did you hear about CP Sport? ………………………………………

General Data Protection Privacy Statement

Cerebral Palsy Sport take your privacy seriously and we will only use your personal information to provide the services and products that you have requested from us.

We would like to keep in touch with you from time to time about the vital work we do for people with cerebral palsy, our participation opportunities, fundraising appeals as well as the services and products you can buy.

If you consent to us contacting you for this purpose, please tick to say how you would like us to contact you:

Post / Email / E-Newsletter / Telephone / Text Message

We will never sell your data and we promise to keep your details safe and secure.

You can change your mind at any time by email or clicking the unsubscribe links if you no longer wish to receive our newsletters.

For further details of how your data is used and stored:

Impairment:

(please √ all that apply)

Cerebral Palsy Visual Impairment Dwarf Amputee

Learning Disability Hearing Impairment

Other (please specify)…………………………………….

Mobility:

Ambulant Wheelchair Frame/Crutches

Please indicate if you have any medical conditions or other disabilities we should be aware of e.g. asthma, allergies.

……………………………………………………………………………………………

Please indicate which of our core activities you are interested in:

Athletics Football TableCricket RaceRunning

Fundraising Swimming SportStart Frame Football

VolunteeringOther (please specify)…………………………………..………..

Donation

Cerebral Palsy Sport relies on the kindness of people like you to help fund a programme of sporting events and activities for children, young people and adults with cerebral palsy. If you would like to make a donation to support more people with cerebral palsy to reach their potential through sport please state the amount you would like to donate below.Thank you.

Please tick if you would like to donate to Cerebral Palsy Sport.

Membership £…………………………………

Donation£…………………………………

Total payment£…………………………………

Gift Aid

Name of UK Taxpayer:

Address of UK Taxpayer (if different to member’s name):

Postcode

I want to gift aid my annual membership subscription of £20 that I have made; will make in the future or have made for the past 4 years to Cerebral Palsy Sport.

I want to gift aid the annual membership subscription that I have purchased for my family member who is aged under 18 at an annual fee of £15 that I have made; will make in the future or have made for the past 4 years to Cerebral Palsy Sport.

I am a UK taxpayer and understand that if I pay less Income tax / Capital Gains tax then the amount of Gift Aid claimed on all my donations during the tax year it is my responsibility to pay any difference.

If you pay income tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Payment Options:

  • I have made a BACS payment: Ref ……………………….

(Account Name: CP Sport. Account number: 58689468.

Sort Code: 30-95-42. Name of Bank: Lloyds)

  • I have enclosed a cheque made payable to CP Sport
  • I wish to pay by Credit/Debit Card

If you are returning this form by email, please call the office to pay rather than completing this section.

Card Type: Credit / Debit (delete as appropriate)

Card Number:

Card Start Date: _ _ / _ _Card End Date: _ _ / _ _

Issue Number (Switch card only): _ _

Card Security Number: (last 3 digits on signature strip)

Cardholder’s name and contact details(if different from member name above)

Name: ……………………………… Address:……………………………

……………………………………………………………………………………

……………………………………… Post Code: …………………………..

Email: ……………………………… Telephone: ………………….……….

Signature: …………………………. Date: ………………………….………

Diversity and equal opportunities at CP Sport

At CP Sport we believe that everyone should have equal chances in life, no matter what their ability, ethnicity, gender, beliefs, circumstances or life experience may be. We want to make sure that our services and support are available to everyone, and that they are used by people from different communities. This makes us stronger as an organisation.

CP Sport aims to support people with cerebral palsy reach their sporting potential.

These include:

  • disabled people and non-disabled people
  • people from black and Asian communities and white people
  • men and women
  • older people and younger people
  • people of different religions or beliefs
  • people of different sexual orientations
  • people who have, or are thinking about, changing their sex
  • people who are single or in committed relationships

You can expect some things from CP Sport.

  • You can expect not to be abused or bullied.
  • You can expect to be treated with respect – it should not matter how you look, whether you are a man or woman, what race you are, how old you are, your sexual orientation, if you are disabled or not, what you believe, who your friends and family are or anything else that makes you different.
  • If you have a complaint, you can expect that we will deal with it quickly. We will not tell anyone who does not need to know.

CP Sport expects some things from you.

  • You should not be rude to, bully or treat anyone at CP Sport badly. This includes staff, people who take part in CP Sport activities, CP Sport members and volunteers.
  • You should treat everyone with respect – it should not matter what they look like, whether they are a man or woman, what race they are, how old they are, their sexual orientation, whether they are disabled or not, what they believe, who their friends and family are or anything else that makes them different.
  • You should tell a CP Sport team member if you think something is happening that

is unfair.

We would appreciate completion of our Diversity Monitoring Form (this is confidential).

Unit 5, Heathcoat Building, Nottingham Science & Technology Park, University Boulevard, Nottingham, NG7 2QJ.

Telephone: 0115 925 7027. Email:

Find out more about the work of CP Sport at

A Limited Company registered in England and Wales, no 04181593. Registered office as shown. Registered Charity No: 1088600