MEMBERSHIP FORM
We need your help…
We need your help to keep our services going. CAN is a unique, fairly small (but significant) user-led charity of
people with learning disabilities, based in Ballymoney, Northern Ireland but working throughout the
Causeway Area up to Ballymena. We are extremely proud of our organisation as it has retained all of the
unique qualities from its inception including remaining user-led and managed, independent, progressive and
proactive. Our underpinning aim is to create an organisation for informed and empowered individuals to
push back the barriers to enable them to have the same fulfilling and creative opportunities as every other
citizen therefore leading to our membership taking control over their own lives and destinies… “Enhancing
Lives…Creating Change” . We work with people with learning disabilities aged 12 and over…we have several
Social Enterprises including Can Can Recycling, Can Can Bazaar (our shop) and Can Can Bubbles, our
launderette. Project S.iNC (Sports & Leisure) works with children aged 12-18 and the Compass Shadow
Council is the first ever elected body of people with learning disabilities. The Base projects (in Ballymena,
Coleraine and Ballymoney) enable people to have an alternative to traditional daycare and to access fun and
leisure activities in their local communities. 100% of the proceeds from our Social Enterprises go to support
local people with learning disabilities. We also campaign for the rights of people with learning disabilities in
our area.
Become a member of CAN and you can:
 Get involved in campaigns and volunteering;
 Help decide CAN's future policies and activities at the CAN AGM.
To join CAN, there is no set fee, just give what you can afford − Your donation will cover all members of your immediate
family − If you have a learning disability, your membership is free! Anyone can join, whether you have a learning
disability, are a carer, belong to an organisation or are someone who just wants to support us. As a member you will
receive a newsletter, and will be able to ask questions and vote at our AGM. It also ensures that you are among the first
to hear what CAN is up to. Our membership enables our staff and trustees to speak from a position of strength when
campaigning, applying for funding or representing the organisation at meetings.
I,
___________________________________
wish to become a member of CAN – Compass Advocacy Network.
My Address is: ____________________________________________________________________________________
My Post Code is: ______________________
My Telephone No. is: _______________________________________
My Mobile No. is: _____________________
My Email address is: ________________________________________
I hereby apply for membership of CAN (Company No. NI 32676, Charity No. XR23013). I support and am in sympathy
with the objects of the organisation as laid down in the Memorandum and Articles. I undertake to contribute such
amount as may be required, NOT EXCEEDING £1, to the organisations’ assets should it be wound up while I am a
member or within 1 year of my ceasing to be a member.
Signature: ______________________________
Date: ___________________
Data Protection: In making your application for membership, your signature will also be your consent to the collection,
holding of and use by CAN of your personal information for the purposes of membership administration.
I do not wish to be kept informed of CAN’s services and activities.
About You:
Which of these are you? Please tick (
) as many as you like.
Person with a learning disability
Parent of someone with a learning disability
Carer of someone with a learning disability
Brother/sister of someone with a learning disability
Supporter
Professional
Volunteer
Other: Please State _____________________________________________________________________
Payment:
If you are able to/or would like to support CAN’s services, please fill in the form below:
I would like to support CAN by donating:
A One-Off Payment of
________
A Monthly Payment of ________
My preferred monthly payment date is: 1st
5th
15th
Name(s) of account holder(s): _______________________
Branch sort code: ___________________
Name and full postal address of your bank or building society:
To the Manager: __________________________
Address: ________________________________
________________________________________
Post code: _______________________________
Instruction to your bank or building society:
Please pay Compass Advocacy Network Charity Direct Debits from the account detailed on this instruction subject to the safeguards
assured by the Direct Debit Guarantee. I understand that this instruction may remain with Compass Advocacy Network and, if so,
details will be passed electronically to my bank/building society. Banks and building societies may not accept Direct Debit
instructions for some types of account.
Signature(s): ____________________________
Date: ___________________
Please return this form to CAN, 20 Seymour Street, Ballymoney, BT53 6JR - not to your bank/building society.
Make your gift worth 28% more at no extra cost to you!
I confirm that I want you to treat this, all gifts four years prior to this date and all future gifts as Gift Aid donations and
that I have paid Income Tax/Capital Gains Tax at least equal to this amount which will be reclaimed by the charity.
Please tick this box if you do not pay Income Tax/Capital Gains Tax:
Please note that for your gifts to qualify for tax relief, you must be paying at least 25p in every £1 you donate. You can cancel the declaration at any time by informing
the charity. If you are no longer paying Income and/or Capital Gains Tax equal to the tax we reclaim you should cancel your declaration. Please advise the charity if
If you would prefer to pay by cheque please visit us at 20 Seymour Street, Ballymoney or call
our Administrator on: 02827669030. Thank you for your kind support.
you change your name and address.