Lancashire

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Membership Subscription Questionnaire

Selnet Membership Application Form

If you need any support completing the form or need it in another format please email us on membership@selnet-uk.com

Contact Details

First Name

Last Name

Job Title

Phone Number

Secondary Contact (Finance / Admin)

Organisation Details

Are you a Social Enterprise? (CIC, Charity, CIO or Community Group)

Yes

Are you based in Lancashire?

Yes

Legal Organisation Name

Trading Name

Organisation Type

Year Established

Registration Number(s)

Registered Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Main Delivery Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Country

Organisation Email

Organisation Phone

Website / Main Social Media Outlet

Delivery Areas

Delivery Areas (please tick all that apply)

Lancashire-wide

Blackburn with Darwen

Blackpool

Burnley

Chorley

Fylde

Hyndburn

Lancaster

Pendle

Preston

Ribble Valley

Rossendale

South Ribble

West Lancashire

Wyre

Other

Please specify

Deliver Outside Lancashire?

Yes

Size & Finance

Number of Volunteers

Number of Employees

Annual Turnover

Income Sources (please tick all that apply)

Trading

Grants

Contracts

Donations

Memberships

Products

Services

Consultancy

Other

Please specify

VAT Registered

Yes

Organisation Activity

Description of Organisation

Main Areas of Work (please tick all that apply)

Employment & Skills

Health & Social

Youth & Education

Environment & Horticulture

Poverty

Equality & Diversity

Arts & Heritage

Housing

Community Development

Business Support

Business Accommodation

Leisure

Digital

Creative and Arts

Inclusion

Other

Please specify

Beneficiary Groups

Young People

Older People

Women/Girls

Disabled People

Ethnic Minority Groups

LGBTQ+ Communities

Refugees/Asylum Seekers

Carers

Ex-Offenders

Socially Isolated

Whole Community

Other

Please specify

Customer Base

Public

Businesses

Charities

Local Authorities

Public Sector

Education

Other

Please specify

Membership Aims

What are you looking for from a Selnet Membership right now?

(Updates, funding alerts, directory listing and general networking)

Stay Connected

(Enhanced profile and access to member-only opportunities)

Grow with Selnet

(At Selnet, we believe collaboration and partnership working helps us create stronger services and better outcomes for our communities)

Partnership Working

How does your organisation currently deliver services? (please tick all that apply)

Independently

In partnership or consortium arrangements

As a subcontractor/under a lead or prime organisation

As a lead or prime organisation

As a subcontractor/under a Service level agreement to Selnet

Please tell us about your experience of working in partnership or collaborating with other organisations to deliver services:

Would you be interested in working with Selnet or other members to deliver services as part of a partnership, consortium or contract in future?

Yes

Maybe - I'd like to explore this further

What key things would you like from your membership? (please tick all that apply)

Networking

Training

Business Support

Funding

Tendering

Advocacy

Visibility

Partnerships

Directory listing

Other

Please specify

Preferred Engagement Method (please tick all that apply)

In-person

Online

1-to-1

Peer Networks

Member Spotlights

Networking Groups

Giving Back

Would you like to give back? (please tick all that apply)

Mentoring

Sharing Knowledge

Speaking

Hosting Visits

Case Studies

Contributing Content

Joint Bids

Not at the Moment

Skills/Expertise to share

Equality, Diversity & Inclusion

Do you have an EDI Policy?

Yes

Charters/Standards

Inclusive Recruitment Approach

Yes

Working Towards It

Communications

Newsletter Consent

Yes

How did you hear about Selnet?

Referral

Event

Social Media

Search Engine

Council/Partner

Bootcamp

Other

Please specify

Final Questions & Declarations

Anything else to tell us?

GDPR: I consent to Selnet processing this information

Yes

Declaration: I confirm the information provided is accurate

Yes

Membership Payment

Based on the information you provided, we’ve identified the membership tier below as the best fit for your organisation. If you have any questions or feel another tier might better serve your needs, please don’t hesitate to reach out to our membership team at membership@selnet-uk.com

Your membership will automatically renew annually unless you cancel your subscription at least 30 days before your renewal date.

Based on the details you shared, you qualify for our Foundation Member level. If you have any questions or feel a different tier might be a better fit, please reach out to our memberships team at membership@selnet-uk.com

£75.00 for each year

Based on the details you shared, you qualify for our Network Member level. If you have any questions or feel a different tier might be a better fit, please reach out to our memberships team at membership@selnet-uk.com

£150.00 for each year

Based on the details you shared, you qualify for our Partner Member level. If you have any questions or feel a different tier might be a better fit, please reach out to our memberships team at membership@selnet-uk.com

£300.00 for each year

Based on the details you shared, you qualify for our Affiliate Member level. If you have any questions or feel a different tier might be a better fit, please reach out to our memberships team at membership@selnet-uk.com

£120.00 for each year

Pay with Card (Stripe)

No payment items has been selected yet

Remember!

As a member of Selnet you will join like-minded businesspeople to share ideas, network, grow and develop, find local connections, and help open your business up to new markets. Through our communications channels, you will receive up to date sector news, funding information, events and training updates and have a platform to promote your business.

For People | For Business | For Good

We look forward to working with you!

CONTACT

Get in touch!

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Office

Brentwood House
Victoria Road, Fulwood
Preston PR2 8PS

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Call

(01772) 200690

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Email

hello@selnet-uk.com

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Hours

M-F: 9am – 5pm
S-S: Closed