Membership Form-CMC

Title*

Mr.Mrs.Ms.Dr.

Full Name*

First NameMiddle NameLast Name

Age

Home Address:*

House Number/Flat Number

Address Line 1

CityCounty

Postal Code

Phone Number

Country CodePhone Number

E-mail*

example@example.com

Are you a student?*

YesNo

Course Name, University and Duration

What Membership are you looking for (Select only one option) *

Individual Membership£10.00

Quantity

Family Membership£15.00

Quantity

Total £0.00

Credit/Debit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Interested in Volunteering CMC Events?

How will my information be used?(Please check the box after going through below info)*

The information that you provide about you and your family will be used to keep a record of your membership. As keeping the logs of members it can be referred by the partnership agencies or organizations like Council, NHS [in Crawley], Police and Fire Services as required. Information that you provide to us will be recorded and stored securely. We understand that some information may be sensitive and we will keep your information confidential and use it only for the purpose of managing members. The only exception to this is if you tell us anything indicating that someone might bein danger; then we have a responsibility to act on that information but we would not do this without telling you and including you in the process.

Consent*

I have read the information above and have had an opportunity to ask questions about the membership and how my information will be used. I understand the purpose of the activity and what my participation involves. I agree to take part in the membership process and for the information I provide to be shared with the Partnership agencies and this in turn allows services that Iuse to share information about me and my family for the purpose of this process. I understand that I need to inform the other members of my family that I have given consent which will allow them to opt out if they wish.

Please verify that you are human*

Application Status(Don't change the status manually)

Once you submit your application, cmc committee will review the membership form and confirm if the membership is approved!!

If you come across any issues while submitting the form or with payments, please contact crawleymalayaleecommunity@gmail.com

Thank you!

CMC Membership Form