Change-Makers Membership Form

Clean Cornwall Change-Maker

Welcome to Clean Cornwall Change Maker sustainable business network. Please complete and submit this form or return to clean.cornwall@cornwallrcc.org.uk We can't wait to make change with you!
Name

First NameLast Name
Email for contact
example@example.com
Organisation
Email for e-invoice
example@example.com
Billing Address

Street Address

Street Address Line 2

CityCounty

Postal Code
Phone Number

Area CodePhone
Annual Membership Category

£90 (>500k)£450 (£500K - £2M)£990 (£2M - £8M)£1,500 (£8M - £20M)£2,000 (£20M+)
Please confirm your choice of membership payment?

Just Giving donationGenerated Invoice
Where did you hear about us?
Payment details

If you have selected to receieve a generated invoice, this will arrive via email in the next few weeks. For Just Giving Payments please go to our Just Giving page and donate the relevant amount for your membership category selected above.

Please sign to confirm
Signature

Clear
Clean Cornwall and the Change-Makers scheme is part of Cornwall Rural Community Charity. Your contribution to this charity project may be tax deductible. Tax when your limited company gives to charity: Donating money - GOV.UK (www.gov.uk)
Should be Empty:

Clean Cornwall Change-Maker