Application to Join LANPAC

Acceptance of this application is based on the results of police checks on the Chief Executive/Proprietor/Partner/Chairman and the organisation. Please be assured that all details given will be held confidentially and will only be for the use of Lancashire Partnership Against Crime (LANPAC) business.

Membership of the Lancashire Partnership Against Crime (LANPAC) can be withdrawn at anytime at the Chairman's discretion. This decision will be final and no further correspondence will be entered into.

Fill in the details on screen and click the SUBMIT button, alternatively print this page and fax to 01772 412129

Name of Chief Executive/Proprietor/Partner/Chairman:

Date of Birth (DD/MM/YY):

Position:

Organisation:

Address:

Telephone No:

e-mail address:

Number Of Employees:

Please tick the appropriate box

Please send me an invoice to cover membership of 2010-2011

Please contact me to arrange a mutually convenient appointment to discuss membership

Once you have submitted this form successfully an e-mail of confirmation will be sent back to you. If you do not recieve this confirmation within 2 working days then please print the completed form and fax to 01772 412129.