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Manchester Disabled People's Access Group

Manchester Disabled People's Access Group

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MDPAG Membership Form

Full membership is open to all disabled people in Manchester and associate membership is open to organisations with an interest in supporting our aims.

I wish to renew/apply for annual membership for 2014. Membership fees at least £1.00 individuals, £10.00 organisations. Fees can be sent to our office or paid at our meeting. You may return this information in any format.

Full Name (required)

Your Address (required)

Contact Home

Contact Work

Contact Mobile

Email (required)

I am registering as an:

I would prefer information as: (You can choose more than 1)
Standard Print (14pt)BrailleEmailLarge PrintAudio CassetteComputer Disk

Do you need the services of a: (You can choose more than 1)
SignerLip ReaderLip SpeakerOther

If other, please state:

Please let us know if you have particular interests in access:

Any information given is held on computer for the sole use of MDPAG and will not be passed on without your consent.

Sign your name in capitals:


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