Membership Survey

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* 1. Full Membership

Individual

Community Organisation

National Organisation

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* 2. Associate Membership

Public Body

Junior (under16)

Other (please state)

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* 3. Members Details:

Name

Name of Organisation

Telephone Number

Address

Post Code

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* 4. Local Authority Area

National

Multiple LA areas

Fife

Aberdeen City

Aberdeenshire

Angus

Argyll and Bute

Clackmannanshire

Dumfries and Galloway

Dundee City

East Ayrshire

East Dunbartonshire

East Lothian

East Renfrewshire

City of Edinburgh

Falkirk

Glasgow City

Highland

Inverclyde

Midlothian

Moray

Na h-Eileanan Siar

North Ayrshire

North Lanarkshire

Orkney Islands

Perth and Kinross

Renfrewshire

Scottish Borders

Shetland Islands

South Ayrshire

South Lanarkshire

Stirling

West Dunbartonshire

West Lothian

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* 5. How did you hear about Scottish Rural Action?

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* 6. If you are joining as an organisation, either local or national, approximately, how many members do you currently have?

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* 7. Please tell us what your interest is in becoming a member

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* 8. Where did you hear about Scottish Rural Action? (please check all applicable)

Social media

Word of mouth

News article

Newsletter from another organisation

Other (please specify)

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* 9. Please let us know if you are happy for us to share the following information with other members

	Yes	No
Name	Name Yes	Name No
Organisation (if applicable)	Organisation (if applicable) Yes	Organisation (if applicable) No
Local Authority	Local Authority Yes	Local Authority No
Email address	Email address Yes	Email address No

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* 10. We will not share your information with any 3rd party organisations. It is your responsibility to amend your details if these change. You will be added to the electronic mailing list if you supply an email address.

To opt out from the electronic mailing list tick here

To receive items by post please tick here

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* 11. I/We support the aims and objectives of Scottish Rural Action;
1. To encourage and actively support the development of an inclusive and sustainable Scottish rural movement that is rooted in Scotland's rural communities and empowers and connects them.
2. To support the organisation of a Scottish Rural Parliament that meets with the purpose of giving a stronger, more coherent voice to Scotland's rural communities and enabling them to engage more effectively with government at all levels
3. To support and promote the development of a Scottish rural movement and Parliament

I agree by submitting this membership form, I am electronically signing the application.

Name

Date

Terms and conditions – full details are available in the Memorandum of Association (see http://www.scottishruralparliament.org.uk/about-us/ or request from the office of SRA).
1. Membership is open to (a) any individual who supports the aims and objectives of Scottish Rural Action (b) any non-statutory corporate body which supports the aims and objectives of Scottish Rural Action (c) any individual who has been nominated for membership by an unincorporated body which supports the aims and objectives of Scottish Rural Action.
2. Members have full voting rights at general meetings. Associate members do not have voting rights.
3. The liability of each member is limited to £1.
4. The directors may, at their discretion, refuse to admit any person or body to membership.
5. The directors shall consider each application for membership at the first directors’ meeting which is held after receipt of the application (and accompanying remittance).
6. Membership subscription will be set and charged at the discretion of the directors.
7. A member may not transfer his/her/its membership to any other person.