EmailMe Form - NAEP Membership Application Form

Are you registering as a new NAEP Member or Renewing your Membership?
New NAEP Member
Renewing NAEP Membership
What is the Invoice Number for your Renewal
Your NAEP Membership Number
Chose the level of NAEP Membership you require: *
Category 1 - Individual Membership £55.56p (Inc VAT)
Category 2 - Commercial Membership £367.38p (Inc VAT)**
Category 2b - Commercial Staff Membership £55.56p (Inc VAT)
Category 3 - Associate Membership £352.92p (Inc VAT)
Category 3b - Associate Named Staff Membership £55.56p (Inc VAT)
**Please note you are entitled to have x1 named person with the Commercial Membership priced at £367.38p Any additional memberships for your organisation are then done under Commercial Membership category 2B which are priced at £55.56p per person.
Collective Membership Person 1
Name, Address and Email
Collective Membership Person 2
Name, Address and Email
Collective Membership Person 3
Name, Address and Email
Collective Membership Person 4
Name, Address and Email
Collective Membership Person 5
Name, Address and Email
What type of organisation do you work for? *
Community Equipment Services - In House
Community Equipment Services – Outsourced
Community Equipment Services – Integrated
Acute
NHS Trust
Social Services
PCT
Voluntary Sector
County Council
Retail – Local Organisation
Retail – National Organisation
Supplier / Manufacturer
Wheelchair Services / Rehab Services
Social Enterprise
Consultancy
Other
Please indicate your region:
Scotland
Northern Ireland
North West
North East and Yorkshire
Wales
Midlands
Eastern
London
Trent
South East
South West
Isle of Man
Other
Name *
First Last
Job Title *
Employing Organisation *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
Email *
Preferred method of contact, including Address, Email or Telephone Number if different from the above:
Preferred method of payment *
Please invoice me directly as per the above address
I will pay online using the PayPal button
Please invoice my organisation at the address below
Please make cheques payable to National Association Equipment Providers
Invoice contact name, address and full contact details if different from above

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