NASAP Membership Registration Form

Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Organisation Name
Business Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
What Type of Partner Will You Be?*

Private Sector Provider Partner (URN Required)Public Sector Provider Partner (URN Required)Third Sector Provider Partner (URN Required)Affiliated Provider Partner (No URN - Limited Access)Professional PartnerCorporate PartnerCommissioning Parter
What Region(s) Do You Cover?*

North EastNorth WestYorkshire & HumberEast MidlandsWest MidlandsEasternGreater LondonSouth EastSouth WestNational
What Type of Membership Do You Want?*

Regional Access - £179.00 per person annuallyNational Access - £399.00 per person annually
What lots are you registered to provide?*

Lot 1 - Solo OccupancyLot 2 - Group Living (Shared Accommodation) - Ring FencedLot 3 - Group Living (Shared Accommodation) - Non Ring FencedLot 4 - Supported LodgingsNon
How many children are you registered to accommodate? (Type 0 if not applicable)*
How many properties/units/homes have you registered? (Type 0 if not applicable)*
Invoice Email Address *

Confirmation Emailexample@example.com
Invoice Details *
Should be Empty: