Northumberland LINk Membership

To become a member of the Northumberland LINk, please fill in the online application form below or you can download the membership form here and return it by post to

Freepost RSAE-TYUU-XKSH
Northumberland LINk,
P.O. Box 205,
Hexham,
Northumberland
NE46 9EA

or contact us at catherinew@adapt-tynedale.org.uk for other ways to apply.

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Surname*:
First name*:
Organisation (if applicable):
Age Group:	less than 2525 - 60over 60
Address 1*:
Address 2*:
Address 3*:
Postcode*:
Telephone:
Mobile phone:
Email:
Fax no.:
Do you require any reasonable adjustments for a disability:
Locality*:	North areaSouth east areaWest area
Permission for your details on web based directory*:	YesNo
Contact preference*:	TelephoneEmailCorrespondence address
Areas of Interest:	Babies & InfantsChildrenYoung AdultsOlder PeopleMental HealthDisabledBlack, Ethnic MinorityGenderSexual OrientationFaithPovertyRuralOther
Other Interests, Please specify:
Time available for the Link:	Less than 1 hour per month1 hour per monthUp to 5 hours per monthOver 5 hours per month
How would you like to become involved?*:	As an active memberAs a support memberOther
How else would you like to be involved?:
Verification:	Fill in the text

Print Contact Details
For more details please contact
Newcastle Heritage Partnership
C/O Ben Smith
Historic Environment Section
Strategy Housing, Planning & Transportation
Regeneration
Newcastle City Council
Civic Centre
Barras Bridge
Newcastle upon Tyne
Tel: 0191 277 7194
info@northumberlandlink.org.uk
www.northumberlandlink.org.uk

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