First name*
 
 
 
 
Last name*
 
 
 
 
Email*
 
 
 
 
Telephone
 
 
 
 
Name of your organisation*
 
 
 
 
Organisation twitter handle:
 
 
 
 
Website
 
 
 
 

We are creating a register of organisations which have made the Make a Stand pledge - this will only include the name of your organisation and no other personal information. 

 
 
 
Do you want your organisation name to appear on the register?*
 
Yes, please add my organisation to the register
No, I don't want my organisation to appear
 
 
 

As the Make a Stand campaign progresses we would like to share information about it and about domestic abuse related services offered by CIH, Women's Aid and DAHA with you. Please confirm below that you are happy for us to contact you. 

 
 
 
Please confirm that you are happy for us to contact you regarding your sign up:*
 
Yes, I am happy to be contacted
No, please don't contact me