MindSpace Business Partnership
Name
*
First Name
Last Name
Business Name
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please select your chosen package, if you would prefer to pay by monthly direct debit, please select the direct debit option and we will send you a direct debit mandate:
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( X )
Community Supporter
£500.00
£
500.00
Wellbeing Partner
£1,000.00
£
1,000.00
Community Champion
£2,500.00
£
2,500.00
Monthly Direct Debit
Free
£
Free
Payment Methods
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Please send me a direct debit form for:
Community Supporter (£42 per month)
Wellbeing Champion (£84 per month)
Space Champion (£209 per month)
Your Agreement:
By signing below, you agree to become a MindSpace partner at your selected tier. You confirm that you accept our standard, plain-English Partner Terms and Conditions, which can be viewed at mindspace.org.uk/partner-terms or requested in print from our team.
Signature
*
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