First name
*
Known as
*
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
By submitting your details to us from this form you are consenting to be contacted regarding your enquiry. Please choose below if you wish to receive marketing communications about relevant CIH products and services. View our full
privacy policy here
.
Please tell us if you would like to stay informed about CIH membership:
*
Yes
No
Please tell us if you would like to stay informed about CIH products and services:
*
Yes
No