Contact Us:

01384 637116

secretary@
derbyshirecare.org.uk

Membership Application

To join us, please complete the information fields.  We will then contact you to confirm your application and subscription amount

 

Group Name Group Address Building Name Street Line 1 Street Line 2 Town/City Post Code Group Phone Number Email Address Care Company Details: Registered Care Provider Owner(if different to above) Full Address (If different to above) Building Name Street Line 1 Street Line 2 Town/City Post Code Main Contact Registered Manager (if Different) Care Home Phone Number Email Address Type of Company (please select primary focus) Number of Beds (Care Homes Only) Declaration: I have completed this form to the best of my knowledge and confirm that the information supplied is accurate at the date of completion. Derbyshire Care Providers Association (DCPA) complies with the requirements of the 1998 Data protection act. DCPA will put this information onto a computer to assist with record keeping, statistical and research purposes and to facilitate ongoing communication.