VSIUK Membership Form – Victim Support International

VICTIM SUPPORT INTERNATIONAL UK

“To support, protect and rehabilitate victims in need.”

MEMBERSHIP APPLICATION FORM

APPLICANT’S INFORMATION

Mr Mrs Ms Others

Surname First name

Nationality :

Address

Post Code:

Occupation: Mobile :

Type of membership:

a. Organisation Membership (annual fees) £30.00 (Thirty pounds) b. Individual [associate member (annual fees)] £20.00 (Twenty pounds)

E-mail :

Name of Organisation (TV, News Portal, News Paper or others Media)

• I confirm that I am 18 years or over

• I agree to abide by the terms and conditions of the Membership which from time to time may be determined by the organisation. I am disclosing the above information voluntarily.

I solemnly declare that I support the aims and objects of the “VICTIM SUPPORT INTERNATIONAL UK” and agree to abide by the rules and regulations of this organisation.

Signature: Date:

FOR OFFICE USE ONLY

I approved above membership details in line with the VICTIM SUPPORT INTERNATIONAL UK terms and conditions.

Membership Number:

Date of Registration :

Remarks :Signature of President/Secretary/Treasurer