Hope - Public - Add | Hope In Swansea

1. Basic Information
Organisation / Support Service Name (required):

Description (required):

Important / Additional Information (This will be pinned to the top of your profile):

3. Address Details
Address Line 1:

Address Line 2:

Town:

County:

Postcode:

Latitude (e.g. 51.62662):

Longitude (e.g. -3.94149):

If you are unsure of your Latitude/Longitude values just leave these blank and we can calculate it using your Postcode.

4. Contact Details
Website Address (including http:// or https://)

Email Address:

This is the public facing email address that will be listed on your support service profile.
Internal Correspondence Email Address (required):

This is an email address that is not made public, but is used internally to correspond with you to keep the support service profile accurate and up to date.
Direct Contact Number:

Please use direct numbers. IF an extension is required please use the support types (These are available once an account is created) and/or additional information fields.
Other Contact Number:

Please use direct numbers. IF an extension is required please use the support types (These are available once an account is created) and/or additional information fields.

6. Account Creation
Username (required):

Password (required):

Confirm Password (required):

Passwords should be at least 8 characters long and contain at least one numbers, one letters and one special character.

7. Privacy

I confirm that the information provided to Matthew`s House for the use of Hope in Swansea is factual, up to date and as accurate as can be at the time of completing this form. I understand it is my responsibility and absolutely necessary to promptly provide updates of this information about our organisation to Matthew`s House when there are changes and I will do this through our portal area. I acknowledge that no responsibility or liability is with Matthew`s House for the accuracy of the information about our organisation. I understand and permit that Matthew`s House and Hope in Swansea will use logos and wording alongside information on Hope in Swansea for the purpose of promoting the services that Matthew`s House and Hope in Swansea have to offer.