Join the Agoriad Database This information will be put on a database of community designers in Wales, and will be accessible to community/voluntary groups looking for professional design services, with the database available as a directory and on the internet. On returning this form you will accept the conditions of the Data Protection Act. General Information Company Name Contact Name Job Title Your Address Enter your Address here Post Code Telephone Number Fax Number Email Website Address Professional Memberships Type Professional Memberships here or None for none Number of employees in company: Please Select From This Menu Sole Proprietor Under 10 10 - 50 Over 50 MARK ALL BOXES THAT APPLY TO YOUR COMPANY Languages Used English Welsh Other Area of operation Wales South Wales Mid & West Wales North Wales Please indicate your usual client base: Businesses Churches Community Groups Developers Government Agencies Individuals Local Authorities Statutory Bodies Other Which skills does your company Offer? Architectural Design Building Conservation Building Surveys Community Development Cost Estimates Desk Top Publishing Disability Access Electrical Engineering Exhibition Design Environmental Appraisal Feasibility Studies Funding & Fundraising Graphic Design Habitat Creation/Surveying Interior Design Landscape Design Landscape Conservation Landscape Management Land Reclamation Lighting Low Energy Design Mechanical & Heating Engineering Office Planning Planning Supervisor Project Management Quantity Surveying Refurbishment Schemes Structural Engineering Site Surveys Urban Design Web Design Other What type of work have you undertaken in the past 4 years? Annual Report Community Arts Community Enterprise Community Halls Displays Early Years Care Educational Environmental Improvement Estate Improvements Gallery or Museum Gardens Health Housing Landscape Management Library Lottery Applications New Build Offices Play Facilities Promotion and marketing Publicity (Leaflets, Logos, etc) Refurbishment/Alteration Religious Sports Grounds Sports Hall/Facilities Theatre/Cinema Woodland Workshops & Studios Other Has your company experience of any of the following: Action Planning Community Participation Consultation Excercises Group Facilitation 'Planning for Real' type exercise Team Building Tenant Participation Other Does your company have Professional Indemnity Insurance Yes No Limit of Indemnity £ Does your company have the following policies available: Community Design Philosophy Environmental/green Equal Oppurtunities Health & Safety Does your company work on: Fee Basis Grant Aided Speculative Voluntary Do you charge a: Daily Rate Flat Rate Percentage Do you charge for an initial meeting? Yes No Have you attended any of the Agoriad Training days or other training on how to work with communities? Yes No Other Training Please input details of other training here or None if that is not appropriate. Practice Information - Please keep under 100 words Practice Information Please input details of your practice here. Practice Experience - Please keep under 100 words Practice Experience Please input details of your practice experience here. Community Projects - Please keep under 100 words Community Projects Please input details of the community projects you have been involved with here. References Reference i Type Reference details here Reference ii Type Reference details here I agree that this information provided is correct and I agree to have this information transferred to a database of community designers in Wales. Name Company Date