membership application form - Manchester Disabled People's Access Group (MDPAG)

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Membership application form

The membership fee is £1.00 for individuals and £10.00 for organisations. Membership is open to all disabled people in Manchester and to organisations of disabled people with an interest in supporting our aims.

If you would prefer not to use our form, please contact us by email or telephone: 0161 273 5033.

Name:
Address:	please add your address
Telephone (daytime):
Telephone (evening):
Mobile Telephone No:
Fax No:
Email Address:
Type of membership:	Individual Membership:	Organisational Membership:
I would prefer information in:	Print (14pt)	Large Print	Braille
	Email	Audio cassette	Computer disk
	CD-ROM	Other format
Do you need the services of a:	BSL interpreter	lip reader/speaker	other interpreter or personal assistant
Do you have other access requirements:	please add other access requirements
Do you have any special interests in access issues?	please add any particular interests in access issues
Any information given is held on computer for the sole use of MDPAG and will not be passed on without your consent. Please note that this is not a secure site and you may prefer to contact our office directly or to print the application form and send it us by post or in any format at: Manchester Disabled People's Access Group, Business Employment Venture Centre, Aked Close, Ardwick, Manchester M12 4AN Telephone (voice or text): 0161 273 5033 Fax: 0161 0161 274 4053 Email: admin@mdpag.org.uk

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