Fields marked * must be completed.

*Name:

*Organisation:

*Job Title:

*Email:

*Email Confirmation:

*Phone (Direct Line):

*Phone (Switchboard):

*Address 1:

Address 2:

Address 3:

*City:

County:

*Postcode:

*Country:

*Size of Organisation:

Please select... expenditure of £10 million or more - £405 with early bird discount, standard price £450 expenditure of £5 million to £10 million - £315 with early bird discount, standard price £350 expenditure of £1 million - £5 million - £270 with early bird discount, standard price £300 expenditure of £1 million or less - £225 with early bird discount, standard price £250

Choose up to three categories that best describe the sector(s) in which you work:

Please select... Animal Welfare Arts/Culture Children/Young People Civil rights/Citizenship/Law and Order Economic/Community development/Employment Education/Training Elderly/Old people Environment/Conservation Grant making Healthcare/Medical research Housing International development People of a particular ethnic or racial origin People with disabilities Religious/Missionary Social care Sport/Recreation Umbrella or resource body

Please select... Animal Welfare Arts/Culture Children/Young People Civil rights/Citizenship/Law and Order Economic/Community development/Employment Education/Training Elderly/Old people Environment/Conservation Grant making Healthcare/Medical research Housing International development People of a particular ethnic or racial origin People with disabilities Religious/Missionary Social care Sport/Recreation Umbrella or resource body

Please select... Animal Welfare Arts/Culture Children/Young People Civil rights/Citizenship/Law and Order Economic/Community development/Employment Education/Training Elderly/Old people Environment/Conservation Grant making Healthcare/Medical research Housing International development People of a particular ethnic or racial origin People with disabilities Religious/Missionary Social care Sport/Recreation Umbrella or resource body

What aspect(s) of governance would you most want to benchmark:

Comments - Do Not Fill This in unless You Are Not Human.:

Interest in the Optional Extras

 We may be interested in the Peer Group Option. In addition to the three 'standard' reports, as a participating organisation, you can elect to compare your governance practices and performance with your choice of around 10 or more other participants.

 We may be interested in the Registered Club Option. Federal or otherwise associated organisations can register for the service as a block. There are discounts if you do work with us in this way. In this way, you automatically have the Peer Group Option at no additional cost.

 We may be interested in Special Arrangements. We form partnerships with selected organisations so that their members can explore governance issues unique to them or from within a special club.

 I agree to the terms and conditions of BoardsCount™.

 We will contact you from time to time about BoardsCount™. We will not pass your contact details to any third party. If you do not want to hear from us, please untick this box.