Make a Stand supporters' pledge

To sign the Make a Stand supporters' pledge please complete this form, we will be in touch shortly after to supply you with your pledge certificate, support pack and other information.

 
 
 
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 supporter's 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:*
 
 
 
 
Please tell us if you would like to stay informed about CIH products and services:*