Equality North East

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First Name	*
Surname	*
Email Address	* You will be asked for your email address when you log-in to the website.
Password	* You will be asked for your password when you log-in to the website. Please choose a password between 4 and 20 characters long.
Company/Organisation Details
Company/Organisation Name	*
Address	*
Town	*
County	*
Postcode	*
Invoice Address Details
My invoice address is the same as my Company/Organisation address
Address	*
Town	*
County	*
Postcode	*
Purchase Order No.
Contact Name
Payment Choice
Individual Voluntary & Community Sector, Social Enterprises & Unions Public & Private Sector Turnover less than £100,000 £10 £50 £100 Turnover £100,000 to £1m n/a £150 £300 Turnover £1m to £100m n/a £250 £600 Equality Champion £600 £600 £600
Payment Method
Please invoice to the address above I will send a cheque made payable to Equality North East

Information disclosed is held and processed by Equality North East, in accordance with the Data Protection Act 1998, for the purposes of compiling Equal Opportunities statistics.

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