Membership registration form

To apply to become a SEWM member, please complete the form below
Please note, all fields marked * are mandatory

About your organisation or business

Label	Field
Registered name: *
Trading name (if different):
Geographical coverage: *
Business sector/s you operate in: *

Membership category

Please tick which category is most appropraite to your application:

Label	Field
Social enterprise: This category is for social enterprises trading and operating in the West Midlands.
Emerging social enterprise: This category is for emerging social enterprises/projects operating or in development prior to legal registration, in the West Midlands.
Networks and partnerships: A network/partnership operating across a smaller geographic area in the West Midlands.
Social enterprise support: An organisation that provides business support and advice to social enterprises in the West Midlands.
Partner organisation: e.g. statutory or corporate bodies that support social enterprise development in the West Midlands.
Individual: e.g. social enterpreneur, or a consultant working with third sector clients in the West Midlands.
Supporter: e.g. national body or network based outside the West Midlands.

Do you wish to subscribe to our weekly round-up?	Yes   No
Do you wish to be included in the online Member Directory on our website?	Yes   No

Please provide a brief description of the work of your organisation or the services you offer. (If applicable, as you wish it to appear on our website - 100 words max): *

Contact details

Label	Field
Main Contact Name: *
Role:
Email: *
Tel:
Website:

Label	Field
Secondary Contact Name:
Role:
Email:
Tel:

Main correspondence address:

Label	Field
Address: *
Street: *
Town/City: *
County: *
Postcode: *