CO3 Trustee Network - Application Form Question Title * 1. Please complete your contact details below: Full name Email address Telephone number Question Title * 2. Are you currently a member of CO3?* Please tick:*Full Membership of CO3 lies with the most senior paid member of staff within an organisation i.e. Chief Executive, Director, Centre Manager, etc. Associate Membership lies with a member of the senior management team. Membership of CO3 is specific to the individual and is not organisational. Yes No Question Title * 3. Organisation name of Board(s) you currently sit on: Question Title * 4. Board position(s) currently held: Chair Vice Chair Treasurer Company Secretary Other (please specify) Membership of the network is free to existing CO3 members who are also trustees. For non CO3 members, membership of the Third Sector Trustee Network is £60 per year. For Boards who would like to sign up more than two of their trustees view the Group Trustee Membership Offer below.For further information on the Trustee Network, please contact:Nora Smith; nora@co3.bz; Tel: 028 90 245 356 Question Title * 5. Group Trustee Membership offer.Please select if you would like to sign up to any of the deals below. 3 - 5 Associate Members Normal rate: £60pp Offer rate: £55pp saving up to: Up to £25 6 - 10 Associate Members Normal rate: £60pp Offer rate:£50pp saving up to: Up to £100 11 + Members £500 flat rate At least £160 Question Title * 6. Please complete the contact details for each person who will be joining as part of the group Trustee membership offer. Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Member Name / Title e.g. Trustee/ Senior Manager / Email Address / Contact Tel Number Done