Champions Sign Up

Thank you for your interest in Chesterfield Champions. To become the latest champion please complete the form below and we will be in touch to confirm your membership.

Name*

Position*

Organisation

Address*

Post Code*

Telephone Number*

Email Address*

Additional Contact: Name

Additional Contact: Position

Additional Contact: Email Address

Additional Contact 2: Name

Additional Contact: Position

Additional Contact 2: Email Address

Number of employees and membership catergory*

Are you interested in recieving information and possibly becoming involved in Action Group *

Yes
No

Why do you want to become a champion?

What is your motivation for becoming a champion (tick all that apply)

Sector:*

Banking/Finance
Construction
Manufactoring/Engineering
Public Sector/Service
Service Industry
Transport/Logisitcs
Broadcast/Media
Education
Marketing/Creative
Recruitment
Sport/Leisure/Entertainment/Tourism
Wholesale
Charity
IT /Telecom
Professional Service
Retail

I agree to be a champion and will be invoiced by Chesterfield Borough Council on behalf of Destination Chesterfield for membership for a calendar year from the date on this form*

I agree

Name*

Date*

Chesterfield - Destination Chesterfield