Organisational Membership Application To apply for Organisational Membership please complete the form below. Please read each question carefully, and respond as fully and accurately as possible. About Your OrganisationName of organisation* Address (line 1)* Address (line 2) Address (line 3)Town or City* County or State* Postcode* Country*Please selectUnited Kingdom—AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweRegion*Please selectEastern EnglandEast MidlandsLondonNorth East EnglandNorth West EnglandSouth East EnglandSouth West EnglandWest MidlandsYorkshire and the HumberScotlandWalesNorthern IrelandChannel IslandsOrganisation telephone number (please include country code)* Organisation website address* What type of organisation are you?* A maintained school (incl. grammar school) or academy in the UK An independent school in the UK A council, LEA or other governmental body A non-UK school or other international educational body A registered charity or CIC (community interest company)? A private business What type of educational establishment are you?* Not an educational establishment Primary Secondary Post-16 SEN Alternative Provision NHS Charity Are you part of a group, or a Trust, or have a parent organisation?* Yes No What is the name and address of the group, Trust, or parent organisation?*Contact DetailsName of Contact for Organisational Membership administration* Email address* Contact telephone number (please include country code)* Finance Details for InvoicingName of Finance contact* Email address of Finance contact* Business registration number (if applicable) VAT registration number (if applicable) Purchase Order Number (if applicable) Membership FeeThere are three fee levels available. If there are less than 3 teachers to be included, we will charge at the individual rate per person (£25 reduced; £75 standard; £125 benefactor).What type of membership are you requesting?* Benefactor Membership £375. This is for organisations that are able to afford to pay it forward, generously supporting others who cannot afford our standard membership fee. Standard Membership £250. This is for organisations able to make a fair contribution to the amount it actually costs MiSP to provide membership benefits to each member. Reduced Membership £125. This is for organisations whose circumstances make it difficult to pay the standard membership fee. Individual Member DetailsPlease provide the names of the MiSP trained teachers or .b Foundations participants who will be included within this organisational membership.1. Name* 2. Name 3. Name 4. Name 5. Name Would you like to add more individuals?* Yes No Please add the names hereThank youThank you for requesting an organisational membership to the Hub. An invoice will be sent to your finance contact shortly. Please use the box below to provide any additional information which it may be helpful for us to know.