Meal Makers Membership Form 2024

Membership Form
Name*

PrefixFirst NameLast Name
Date of Birth*

DayMonthYear
If applying as a couple - Second Applicant

PrefixFirst NameLast Name
Second Applicant Birth Date

DayMonthYear
Phone Number *
Address*

Street Address

Street Address Line 2

Town or CityLocal Authority

Post Code
Email
example@example.com
Emergency Contact (this can be family/friend/neighbour/professional etc)*

First NameLast Name
Emergency Contact relationship to applicant*
Emergency contact email address
Emergency Contact Phone Number *
Do you already receive any Food Train service from a Branch?
Referrer name:*

First NameLast Name
Referrer Job Title (if applicable)
Organisation name (if applicable)
Referrer Phone Number *
Referrer Email*
example@example.com
Where did you hear about this service? *
Are there any dietary requirements?
Relevant information (e.g. health, hearing, mobility, sight, communication, pets in the home, smoker, access issues or any other matters that Food Train staff and volunteers should be aware of.)
YesNo
Interesting facts the Diner would like to tell a potential volunteer match about themselves. (e.g. I used to be a ballet dancer, I once met Prince Philip, my family all live in New Zealand now)
£5 monthly£60 annually
Our payment method is Direct Debit; all payments collected by Direct Debit are protected by the Direct Debit Guarantee, which offers you safety and security. The annual membership fee of £1 and subscription fee of £5 per month or £60 per year will be collected when we are able to match the Diner with a Cook in their area and renewed annually as long as they are still a member of the service. Details will be deleted from our records after the Direct Debit is set up.*

I have the bank detailsContact referrer for bank detailsContact emergency contact for bank detailsContact individual for bank details
Bank Details
YesNo
Pension Credit Information

If you would like to know more about entitlement to pension credit, housing benefit, carers allowance, council tax support and attendance allowance, you can call Age Scotland helpline which is a free, confidential service for older people, their carers and families in Scotland. 0800 12 44 222
Yes
Should be Empty:

Membership Form

Pension Credit Information