We Are Wakefield

Title *

If other, please state

Forename *

Other Initials

Surname *

Company Name *

Job Title *

Company Address *

Are you a Charity *

If you answered yes, please pur your Charity Number below

Number of Employees *

Email Address *

Telephone Number *

Second Contact: Name

Second Contact: Job Title

Second Contact: Email Address

Please select the groups that you wish to join. The Chair of the Group will then make contact with to inform you of the quarterly meeting dates. (You can select multiple groups)

Your Authorisation *

Monthly Direct Debit

One-off Annual Fee (Save 10%)

Data Protection (The Wakefield Bondholder Scheme will process your membership information for administration purposes. We may also send you newsletters and let you know about other members’ services) *

Please tick If you do not want any information relating to other members’ services.

Please tick If you do not want us to share your information.

Membership Application Form