Registered Charity Number: 1061953, Registered Company Number: 3289949Registered Office: 10 Oakham Court, Preston PR1 3XP.

PDVS is authorised to provide immigration advice and services by the Immigration Services Commissioner – No. N200500027

PDVS acknowledges funding from the following organisations:

Preston Domestic Violence Services (Incorporating Chorley Women’s Refuge)

Office Address: 10 Oakham Court, Preston PR1 3XP24 hour Domestic Violence Helpline: 01772 201601Umeed Helpline: 01772 514101Fax: 01772 201701 Office: 01772 201301Email: enquiries@pdvs.org.ukWebsite: www.pdvs.org.uk Umeed website: www.umeed1.org.uk

MEMBERSHIP APPLICATION FORMIf you are a woman aged 18 years or over why not show your support for Preston Domestic Violence Services by becoming a member of the Charity. To do so please complete the form below and send it to Preston Domestic Violence Services, 10 Oakham Court, Preston PR1 3XP with the required membership fee. Only women are allowed to become members.

Name ……………………………………………………………………….

Address ……………………………………………………………………….

……………………………………………………………………….

Tel Home …………………….. Work ………………………………..

Mobile ……………………. Email ……………………………….

Date of Birth ……………………………………..

I am a service user YES / NO

I am a previous employee of PWR YES / NO

The membership year runs from 1st November to 31st October. Applications submitted after 1st

June will be charged at half the appropriate rate for the remainder of that year only.

Fee enclosed ……………(£5 waged / £2 low or unwaged / no charge for service user)

I agree to abide by the rules of Preston Domestic Violence Services as set out in the Company’s Articles of Association and Memorandum of Association.

Signed ……………………………………………….. Date …………………………………

Please return this form with your payment to: Preston Domestic Violence Services, 10 Oakham Court, Preston PR1 3XP.

Thank you

Registered Charity Number: 1061953, Registered Company Number: 3289949Registered Office: 10 Oakham Court, Preston PR1 3XP.

PDVS is authorised to provide immigration advice and services by the Immigration Services Commissioner – No. N200500027

PDVS acknowledges funding from the following organisations:

Preston Domestic Violence Services (Incorporating Chorley Women’s Refuge)

Office Address: 10 Oakham Court, Preston PR1 3XP24 hour Domestic Violence Helpline: 01772 201601Umeed Helpline: 01772 514101Fax: 01772 201701 Office: 01772 201301Email: enquiries@pdvs.org.ukWebsite: www.pdvs.org.uk Umeed website: www.umeed1.org.uk