Jude Lodge (Tiverton House),Tiverton Road,Bransholme, Hull, HU7 4DQ
Office Tel: 01482 878778, Textphone: 01482 370986, Fax: 01482 370999
Email: office@choicesandrights.org.uk
Website: http://www.choicesandrights.org.uk
Choices & Rights Membership Form
Membership is free.
Choices and Rights is a Registered Charity.
Member of the National Centre for Independent
Living.
Anyone in the Hull and East Riding area can
join, but only Disabled people can be full
members with voting rights.
PLEASE NOTE: Choices & Rights will NOT pass on your
details to any other person or organisation without your
permission.
PLEASE COMPLETE FORM IN BLOCK CAPITALS
Title:
Forename(s):
Surname:
Address:
Home Telephone no:
Work Telephone no:
Email address:
Mobile no:
Signature:
Disabled: (please tick appropriate box)
Date:
YES
NO
A company Limited by Guarantee Registered in England, No. 3982194
Charity No: 1106462
Affiliated to DIAL UK
Jude Lodge (Tiverton House),Tiverton Road,Bransholme, Hull, HU7 4DQ
Office Tel: 01482 878778, Textphone: 01482 370986, Fax: 01482 370999
Email: office@choicesandrights.org.uk
Website: http://www.choicesandrights.org.uk
PLEASE RETURN COMPLETED FORM TO CHOICES AND
RIGHTS, AT THE ADDRESS ON THE TOP OF THE FORM.
A company Limited by Guarantee Registered in England, No. 3982194
Charity No: 1106462
Affiliated to DIAL UK