HCT Regional Affiliates membership

Please note: Rates are annual and payments are taken by Direct Debit.

Completing this form will register a new HCT affiliation for your group. If your group is a current or previous affiliate and you want to renew your membership or set up a new Direct Debit to pay it, please email us instead for advice at nationaladmin@keepournhspublic.com

Payments will likely appear on your bank statement as 'GoCardless', the name of the payment processing platform.

HCT Regional Affiliate £300 per year, renews automatically

Membership *

HCT Regional Affiliate - £ 300.00

Please renew my membership automatically.

Total Amount

HCT Regional Affiliate

Group's Name *

HCT Regional Affiliate type *

Please enter here the email address we should use to correspond with your group. (This can be the same as the personal one you enter in the 'your details' section below, if necessary).

Email for contacting group *

Select the region or devolved nation within the UK that your organisation is based in. Leave blank if your organisation is a UK-wide organisation.

Region

You can optionally provide a phone and an address for your group.

Phone

Street Address

Town or city

Postal Code

Please enter your personal details below, so we know who is signing up for the group/organisation.

Your details

First Name *

Last Name *

Your email