HCT National Affiliate memberships

Completing this form will submit an application for 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

Fees and payment to be negotiated.

HCT National Affiliate - price to be negotiated after we have received your details.

Membership *

National affiliate

Total Amount

HCT National Affiliate

Organisation's Name *

HCT National Affiliate type

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

Email for organisation *

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

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

Payment Options

[x] We will contact you to discuss fees and payment

Please note: The 'contribute' button submits your form but will not result in a payment being charged. We will get in touch to negotiate the fee and arrange payment.