Senior Council for Devon

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Senior Council for Devon Membership Form for Groups and Organistaions

Your personal information and Data Protection Notice

The information which you provide on this form will be held by  the Senior Council for Devon. This information will be used by the Senior Council for the purposes of keeping in contact with members and involving them in the way they prefer.

Your personal information will be kept secure and will not be held for any longer than is necessary. We will not disclose any information which would identify you, to anyone else, unless you give us your permission to do so. If you have any queries about this, please contact the Senior Council for Devon.

Group / Organisation
Are you (please tick box that applies)

A Group/organisation run by older people

A service provider

(Please note that a group or organisation run by older people can become a full member, and a service provider organisation an associate member. The Better Government for Older People model excludes provider organisations from full voting membership as they are not associations of older people. However, they can participate as associate members to support the work of the Senior Council. For organisations, the local senior council will be the usual point of entry, for membership or co-option, depending on their area of operation.)

Description of group/organisation (please provide brief description of organisation including role, number of members, when established, membership fee – please attach constitution or terms of reference)
Description
Address
Post Code
Senior Council market or coastal town area or areas of operation.


( See Map- please select the area or areas you most identify with if unsure of the boundary)
Telephone Number
Email address
Fax Number
How would your group/organisation like to be involved ?
(You can change your involvement at any time by contacting us).

Please tick ALL the boxes that are right for you

Receiving information out about local services
Taking part in consultation about local services
Event/meeting attendance
Helping run my local senior council
Contributing your skills and time in other ways*

*If yes please give details

The senior council aims to give voice to issues that you may have with the intention of changing things for the better.

What are your group/organisation,s top three concerns?

1
2
3

Description of any skills and interests your group/organisation has
Information about your group/organisation
The Senior Council for Devon is open to ALL people aged 50+. To ensure that we are representative/inclusive and reflect the older population across Devon, it would help us to know a little bit about your group.

Please tick (if known) which gender,age bands, and ethnic groups membership of your group/organisation covers

Gender:
Male Female


Age range:
For organisations providing for a wider age range than 50+ please estimate
percentage of members aged 50+ %


Does your membership focus particularly on any of the following age bands:
50-59
60-69
70-79
80-89
90+

Ethnic group:
If your membership is specifically aimed at particular ethnic groups please
provide information
Other groups or organisations that your group/organisation belongs to for people 50+
Preferred method of communication:
By post By email
(Email is more environmentally friendly)
Please return this form to:
Senior Council for Devon,
PO Box 210,
Harberton,
Totnes,
TQ9 9DA

Signed

Date