Membership Application

Complete the membership form below to become a member of the EnviroCluster. If you are having problems with this form, you can download the membership form here, complete it, and email it to info@envirocluster.co.uk

Company Name*
Brief Company Overview*

Please provide a brief overview of your company. Use the next box to detail the products and services you offer.
Description of Company's Cleantech Products & Services*

Please be sure to tell us how your products or services are greener, cleaner or less harmful to the environment than alternative solutions.
Company Address*
Post Code*
What is the primary sector in which you operate?*
Other Sector*

What sector is your business operating in?
Company Website*

Type N/A if you do not have a website.
Company Phone Number*

Please enter the phone number for your company that you would like to be published. You can enter your own contact number on the last page.
Company Email*

Please enter the email address for your company that you would like to be published. You can enter your own email address on the last page.
What year was your company established?*
How many employees work for your company?*

If you do not know, please estimate or give a range.
What is the annual turnover of your company?*

All information you provide on company turnover will be kept confidential and will not be published. If you do not wish to provide this information, type N/A in the box.
What percentage of your company's turnover is from cleantech products and services?*

If you do not know, please estimate or give a range.
Company Logo

We require a company logo for the showcase. You can upload one now, or you can send one later by email (instructions on how to do this will be in your confirmation email).
Optional Information

All of the information collected in this section will be kept confidential and will not be published.

Whilst you are more than welcome to skip this section entirely and go to the last section, we advise you to complete this information as it allows us to gain a more complete assessment of the cleantech sector and enables us to provide you with tailor-made information and support in order to help you grow your business. Please feel free to use bullet points.
What percentage of company turnover is from outside of the country?

If you do not know, please estimate or give a range.
What are the main markets for your cleantech products & services?

Please provide a list of countries or sectors.
Where do you think your main cleantech markets will be in five years time?

Please provide a list of countries or sectors.
Who are the types of clients that you sell to?

E.g. public sector, private companies, consumers, water utility companies.
How do you intend to finance your future business activities?

E.g. venture capital, business angels, bank loans, grants, personal finance.
What skills provision does your company need? Are you finding it difficult to recruit people with the required skills?

We are engaged in driving the UK’s green skills agenda and welcome any feedback you have on skills issues in your business which are restricting growth and development.
What support would be beneficial to you in order to grow and develop your business?

Please tell us what you need in order for your business to grow. E.g. skilled workers, funding, internationalisation support, innovation support, business advice, coaching etc.
Your Contact Details

We will not publish your personal contact details. We use this information to contact you if we have any requests for further information or to put you in direct contact with clients and customers interested in your products or services.
Name*

First
Last
Job Title*
Email*
Phone Number*
Mobile Phone Number
Twitter Account

If your company has a Twitter account, please tell us your account name so we can follow you.
Would you like to receive email updates from us on funding opportunities, networking activities, innovation partnering requests and events?*
- Yes
- No
Emails will be sent to your email address and not the company email address. You can unsubscribe at any time.
As your company is operating in the water & wastewater sector, would you also like to receive our Water Innovation Network newsletter by email?*
- Yes
- No
The Water Innovation Network newsletter features opportunities and event notifications for supply chain companies in the water industry. More details on the network can be found at www.waterinnovation.net. Emails will be sent to your email address and not the company email address. You can unsubscribe at any time.
Do you agree to letting us publish the information provided in our cleantech showcase?*
- I agree
- I do not agree
We will only publish non-sensitive data including your company name, description, contact details, logo and number of employees. We will not publish your personal contact details, any information given on your turnover or information that you provided in the “optional information” section on markets, clients, skills and support.

Membership Application

Optional Information

Your Contact Details

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