About your business

 

Business name

 

 

 

 

What services does your business provide?

 

 

 

Does your business provide any specific services/products for people with a disability?

 

 

 

Number of staff

 

 

 

Would you be willing to offer any discounts for MAD Scotland members?

 

 

Contact details

 

Named contact for all communication

 

 

 

Contact postal address

 

 

 

Contact telephone number

 

 

 

Contact email address

 

 

 

Business  website

 

 

Data Protection (please tick)

 

Can we share your contact email and website address on our website?

 

 

 

Can we use your details to contact you about news and events from MAD Scotland?

 

 

Membership

 

Registration for businesses is £100 and this entitles you to free lifetime membership.

Members of staff may purchase a range of merchandise – available from our website. In addition to the free certificate of registration we also have window stickers available at a cost of £5.00. Would you like to purchase one for your business (if yes, please include appropriate fee along with your initial registration fee.

 

 

 

Signed

 

 

Date