Associate Application Form
Your Details
Name
_______________________________________________________
Position
_______________________________________________________
Organisation
_______________________________________________________
Address
_____________________________________________________________________
_____________________________________________________________________
Telephone
_______________________________________________________
Email
_______________________________________________________
Organisation website __________________________________________________
Type of Company ___________________________ Charity Number _________________________
Type of Membership (please tick)
Free Word International Associate (£100 + VAT a year)
Free Word Associate 150 (£150 + VAT a year)
Free Word Associate 250 (£250 + VAT a year)
Free Word Associate 450 (£450 + VAT a year)
Membership for Profit Making Organisations (£350 + VAT a year)
Do you wish to use Free Word as a registered office (£150 + VAT a year)
What is the main purpose of your organisation?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What areas of literature, literacy or free expression do you work in most?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Why would Associate membership of Free Word be useful to you?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Do you know or work with any of our current Residents and Associates? If so, which ones(s)?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How did you hear about the Associate scheme?
__________________________________________________________________________________
__________________________________________________________________________________
Declaration
I wish to become an Associate of Free Word and support Free Word’s vision of the transformative
power of words.
Signature
_____________________________________________
Date
_____________________________________________
Applications should be sent to lauren@freewordcentre.com
All applications will be responded to within 30 days. Organisations that are successful will be
invoices for their membership and membership will commence with the receipt of payment.
Free Word reserves the right to refuse Associateship or terminate Associateship at any time. If
Associateship is terminated by Free Word for whatever reason, Free Word will refund the
membership amount equivalent to the fraction of the year that you have left.
Associates who terminate their membership during the year will not be eligible for a refund.