APPLICATION TO BECOME A VOLUNTEER


  Your details

Please enter your first name:

Please enter your surname:
    
Address:

Postal Town or City:

County/area:

Country:

Postcode or ZIP Code:

Date of birth (optional - not required):

Daytime telephone number:

Please enter your e-mail address
(if you wish to receive confirmation of your membership)

It would be helpful to know where you heard about us
(optional - not required):
  REFERENCE 1

First name:

Surname:
    
Address:

Postal Town or City:

County/area:

Country:

Postcode or ZIP Code:

How long has this person knowing you and in what capacity


   REFERENCE 2

First name:

Surname:
    
Address:

Postal Town or City:

County/area:

Country:

Postcode or ZIP Code:

How long has this person knowing you and in what capacity

   VOLUNTARY ACTIVITIES
Please indicate what type of volunteering activities you are interested in:
Supporting/Befriending
Fundraising
Promotional
Telephone Help line
Administration
Other (please specify)



   ABOUT YOU

Please tell us about any relevant experience, skills, achievements and interests


   REHABILITATION OF OFFENDERS ACT 1974

The provision of the above Act provide protection against discrimination to people who have criminal record. Please provide details of any criminal convictions below.

DECLARATION
I confirm that all the information provided in this form is correct and give my consent to NEPAS undertaking a police check where appropriate.
( Tick in the box to give nepas consent)