{"id":23,"date":"2017-07-11T10:42:48","date_gmt":"2017-07-11T09:42:48","guid":{"rendered":"http:\/\/89.145.103.204\/~alliancescotland\/membership\/?page_id=23"},"modified":"2024-06-25T11:02:39","modified_gmt":"2024-06-25T10:02:39","slug":"individual-online-application-form","status":"publish","type":"page","link":"https:\/\/www.alliance-scotland.org.uk\/membership\/become-a-member\/individual-online-application-form\/","title":{"rendered":"Individual online application form"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Privacy Statement<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The ALLIANCE is committed to ensuring that your privacy is protected. The personal data on this form is being collected for the following purpose: to manage your membership and keep you informed about the work of the ALLIANCE and issues relating to the health and social care agenda including events and training. We may also forward you information from third parties that we think may be of interest to you.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The ALLIANCE and its sub-contractors will not distribute or disclose your personal information to third parties unless we have your written permission or are required by law to do so. We comply with the Data Protection Act 1998 and GDPR (May 2018) when handling your personal information. If you have any concerns about how we use your personal information, contact Head of Finance and IT at: <a href=\"mailto:DPO@alliance-scotland.org.uk\">DPO@alliance-scotland.org.uk<\/a>. Alternatively, you have the right to complain to the <a href=\"https:\/\/ico.org.uk\/concerns\/\">ICO https:\/\/ico.org.uk\/concerns\/ (this link will take you away from our website).<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You also have the right to object to how we process your personal information, the right to access, correct, sometimes delete and restrict the personal and sensitive personal information we use. Together with the right to receive your information in a machine-readable format for transfer to another organisation and not to be subject to a decision based solely on automated processing, including profiling<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We will retain your personal information for the duration of your membership. For our full <a href=\"https:\/\/www.alliance-scotland.org.uk\/privacy-policy\/\">privacy policy<\/a>, please visit our website.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By signing this form you are consenting to us processing your personal information for the above purposes, which is our legal basis for processing your personal information.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Individual Supporter Application Form<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/membership\/wp-json\/wp\/v2\/pages\/23#gf_1' data-formid='1' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcV7f8jAAAAAJ6KQ3vjFlFQKiDIOuG3SYqwfPeq' data-tabindex='0'><input id=\"input_d6940e429b33b630150a5335bca4b629\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_d6940e429b33b630150a5335bca4b629\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_28\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_28'><span class='gform-field-label__text'>Facebook<\/span><\/label><div class='ginput_container'><input name='input_28' id='input_1_28' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_28'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Membership details<\/h3><\/div><fieldset id=\"field_1_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1_3'>\n                            <span id='input_1_3_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_3_2' class='gform-field-label gform-field-label--type-sub '>Title<\/label>\n                                                    <select name='input_3.2' id='input_1_3_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Mr' >Mr<\/option><option value='Mrs' >Mrs<\/option><option value='Miss' >Miss<\/option><option value='Ms' >Ms<\/option><option value='Mx' >Mx<\/option><option value='Dr' >Dr<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                  <\/span>\n                            <span id='input_1_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_3_3' class='gform-field-label gform-field-label--type-sub '>First name<\/label>\n                                                    <input type='text' name='input_3.3' id='input_1_3_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_1_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_3_6' class='gform-field-label gform-field-label--type-sub '>Last name<\/label>\n                                                            <input type='text' name='input_3.6' id='input_1_3_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-uk gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Contact telephone number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_1_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_1_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_1_6\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_1_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_6_1_container' >\n                                        <label for='input_1_6_1' id='input_1_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_6.1' id='input_1_6_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_6_3_container' >\n                                    <label for='input_1_6_3' id='input_1_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''    aria-required='false'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_1_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_6_5_container' >\n                                    <label for='input_1_6_5' id='input_1_6_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_6.5' id='input_1_6_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_1_6_6' value='GB' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_1_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Preferred method of contact<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_15'>\n\t\t\t<div class='gchoice gchoice_1_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Email'  id='choice_1_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_0' id='label_1_15_0' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Phone'  id='choice_1_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Post'  id='choice_1_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_2' id='label_1_15_2' class='gform-field-label gform-field-label--type-inline'>Post<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ALLIANCE Involvement Network<\/h3><div class='gsection_description' id='gfield_description_1_7'>By joining the ALLIANCE involvement network, you are registering your interest to be contacted directly to take part in campaigning and policy activities. \n\nMore information about this network can be found on our website here: https:\/\/www.alliance-scotland.org.uk\/membership\/involvement-network\/<\/div><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Please indicate if you want to join the ALLIANCE Involvement Network<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_8'>\n\t\t\t<div class='gchoice gchoice_1_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='I do want to join the Involvement Network'  id='choice_1_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>I do want to join the Involvement Network<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_19\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Communication preferences<\/h3><div class='gsection_description' id='gfield_description_1_19'>As well as receiving our weekly bulletin and exclusive monthly newsletter please tick if you wish to be added to the following ALLIANCE mailing lists. <\/div><\/div><fieldset id=\"field_1_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Additional ALLIANCE newsletters<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_12'><div class='gchoice gchoice_1_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='Person Centred Voices'  id='choice_1_12_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>Person Centred Voices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Women&#039;s Health Mailing List'  id='choice_1_12_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'>Women&#8217;s Health Mailing List<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='Digital Digest'  id='choice_1_12_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_3' id='label_1_12_3' class='gform-field-label gform-field-label--type-inline'>Digital Digest<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_12_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.4' type='checkbox'  value='Children and Young People Mailing List'  id='choice_1_12_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_4' id='label_1_12_4' class='gform-field-label gform-field-label--type-inline'>Children and Young People Mailing List<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_12_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.5' type='checkbox'  value='Scottish Sensory Hub Newsletter'  id='choice_1_12_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_12_5' id='label_1_12_5' class='gform-field-label gform-field-label--type-inline'>Scottish Sensory Hub Newsletter<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referral and discovery information<\/h3><div class='gsection_description' id='gfield_description_1_20'>Please tell us how you first heard about membership of the ALLIANCE. This helps us understand how members discover our work and improve how we reach and engage with new members. <\/div><\/div><fieldset id=\"field_1_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>How did you find out about ALLIANCE Membership?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_25'><div class='gchoice gchoice_1_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='ALLIANCE weekly bulletin'  id='choice_1_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_1' id='label_1_25_1' class='gform-field-label gform-field-label--type-inline'>ALLIANCE weekly bulletin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.2' type='checkbox'  value='ALLIANCE website'  id='choice_1_25_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_2' id='label_1_25_2' class='gform-field-label gform-field-label--type-inline'>ALLIANCE website<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.3' type='checkbox'  value='ALLIANCE event'  id='choice_1_25_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_3' id='label_1_25_3' class='gform-field-label gform-field-label--type-inline'>ALLIANCE event<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.4' type='checkbox'  value='Member referral'  id='choice_1_25_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_4' id='label_1_25_4' class='gform-field-label gform-field-label--type-inline'>Member referral<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.5' type='checkbox'  value='Social media'  id='choice_1_25_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_5' id='label_1_25_5' class='gform-field-label gform-field-label--type-inline'>Social media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.6' type='checkbox'  value='Referral from an ALLIANCE colleague*'  id='choice_1_25_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_25_6' id='label_1_25_6' class='gform-field-label gform-field-label--type-inline'>Referral from an ALLIANCE colleague*<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_25_7'>\n\t\t\t\t\t\t\t\t<input 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