Membership Application Form (Organisations)

To access support from One Walsall you’ll need to register as a member. Membership is free to organisations which are charitable or operate on a not-for-profit basis and working in Walsall. This includes community groups, charities, faith organisations, charitable incorporated organisations and social enterprises.

If you have any queries about membership please call the Development Team on 01922 619 840.

Please complete all sections of the form as incomplete applications may cause a delay.

About your organisation
Legal Name of Organisation
(as it appears on your governing document)
Any other name your organisation is known by
Organisation type (tick all that apply)
(We will ask you for your organisation’s governing document when we review your application) / Constituted community group
Registered Charity
Company Limited By Guarantee
Charitable Incorporated Organisation
Community Interest Company
Faith organisation
Other (please specify):
Charity Number (if applicable)
Company Number (if applicable)
Business address (including postcode)
Website
Twitter account
Facebook account
What was your organisation’s income in the last financial year?
Main areas of work (select up to three)
Abuse & Survivor Services / Advice & Information Services
Advocacy / Alcohol & Substance Misuse
Animal Welfare / Arts, Music, Culture & Heritage
Carers / Children & Young People
Community Development / Counselling
Crime Community Safety / Education & Training
Employment & Economic Regeneration / Environmental & Green Spaces
Family Support & Parenting / Health & Wellbeing
Sexual Health / Housing/Homelessness
Learning Disability / Lesbian, Gay, Bisexual & Transsexual
Physical Disability & Sensory Impairment / Mental Health
Religion & Faith / Social Activities
Sport & Leisure / Tenants & Residents Association
Older Adults / Other (please specify)
Main Areas Served (select all that apply)
North Walsall (including Bloxwich East & West, Blakenall, Birchills Leamore) / Walsall East (including Brownhills, Pelsall, Rushall- Shellfield, Aldridge, Walsall Wood, Streetly, Pheasy Park Farm)
South Walsall (including St Mathews, Pleck, Paddock and Palfrey) / West Walsall (including Willenhall, Short Heath, Bentley and Darlaston)
Main Contact
This is the person who we expect to have the majority of contact with about support and advice services we offer.
Title
First Name
Last Name
Position/Job Title
Main telephone number
Mobile number
Email address
Authorised Representative
Organisations who are members of One Walsall are required to nominate an Authorised Representative. The Authorised Representative is the person who will represent your organisation at General Meetings and can be nominated to become a Trustee of One Walsall.
The Authorised Representativeshould be someone who holds a senior position in the organisation (e.g. a Senior Officer or Trustee). We can still work with any other member of your organisation in a support capacity.
If you wish the Authorised Representative to be the same as the Main Contact, please leave the next section blank.
Title
First Name
Last Name
Position/Job Title
Main telephone number
Mobile number
Email address
Declaration
Please tick the boxes to confirm:
You have the authority to complete this membership form on behalf of your organisation
You commit to One Walsall’s Mission, Values and Objects
You agree that you meet the criteria for becoming a Member of One Walsall.
You agree for One Walsall to hold your details on our Members Database
You are happy to provide further information should we require it to ensure that you meet the criteria for Membership.
One Walsall is a Company Limited by Guarantee, therefore member organisations will be included on the Company Register of Members. In the event of One Walsall being wound up members will be required to pay the sum of £1.
Name
Date

Thank you for completing this application form. We will contact you shortly to confirm your membership and discuss how we might support your organisation.