top of page

CRM REGISTRATION FORM

Workplace Advocacy Membership Registration Form

Please complete the registration form below to provide your contact details and authorise us to act on your behalf when required.

​

After submitting your registration, you will be automatically directed to our appointment booking page to schedule your Case Review and Strategy Session.

​

No payment is required at this stage. Your chosen payment method will be arranged securely during the booking process.

We look forward to supporting you.

​

Register your details by completing the form below.

​

This form should take approximately 5–7 minutes to complete.

Who do you work for? Leave blank if self-employed as a sole trader.

Enter your current job title or role. If you're self-employed, you can enter 'Sole Trader' or your business function.

Title
Date of Birth
Day
Month
Year

We require your date of birth so we can communicate on your behalf with your signed consent letter, and to verify your identity in line with our GDPR obligations.

Multi-line address

I authorise Westminster Advocate Service to communicate on my behalf. My information will not be shared with third parties unless I provide explicit authorisation. Please sign below.

Select a Membership Plan (required):
Advocacy Support at Work – 210 minutes/month - £300 per month
Advocacy Support at Work – 300 minutes/month - £449 per month
30 minutes - a one-off session, not part of any membership – £65

Prices shown are subject to 20% VAT.

How do you intend to pay? (please select one):
Access to Work scheme
Direct Payment
Self-funded
What is your gender? (Optional — for registration purposes only)
Female
Male
What is your disability or condition?
Deaf or Hard of Hearing
Blind or Visually Impaired
Speech or Communication Difficulty
Physical Disability or Mobility Impairment
Chronic Health Condition (e.g. epilepsy, diabetes, ME/CFS)
Neurodivergent (e.g. autism, ADHD)
Mental Health Condition (e.g. anxiety, depression)
Learning Disability or Difficulty (e.g. dyslexia, dyspraxia)
Acquired Brain Injury
Long COVID
Other (please specify)

Westminster Advocate Service is committed to protecting your personal data in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.


The information you provide will be used solely for advocacy purposes and will not be shared with any third party without your explicit consent, except where disclosure is required by law.


HOW WE USE YOUR DATA​​

  1. To assess and process your registration

  2. To contact you regarding your enquiry

  3. To provide advocacy services as requested

  4. To comply with legal and regulatory obligations


Click here to read our full Privacy Policy.

​

IMPORTANT NOTICE

  1. Membership fees are based on reserved availability, not actual usage.

  2. Unused minutes are non-refundable and cannot be carried forward.

  3. By submitting this form, you agree to enter into a service agreement with Westminster Advocate Service.

  4. Invoices are generated monthly.

  5. Accepted payment methods include: Access to Work, Direct Payment, or Self-funding.


TERMINATION POLICY

  1. All memberships require 30 days’ written notice to terminate.

  2. No refunds will be issued for unused minutes during the notice period.

  3. If no formal notice is received, billing will continue until a 30-day written notice is provided.

I understand and accept that by submitting this form I am entering into a service agreement with Westminster Advocate Service.
I agree
I confirm that I have read and agree to the Privacy Policy and consent to the processing of my personal data as outlined below.
I agree
I understand that monthly invoices must be paid either personally or via Access to Work.
I agree
bottom of page