Main Contact DetailsName* First Last Company / Organisation*Job Title*Brief summary of company / organisation core business*Address* Street Address Address Line 2 City Post Code Telephone Number*Mobile Number*Email Address* Website address* Are you a member of any of the following associations?Association of Convenience Stores (ACS)Aerospace, Defence and Space Group (ADS)Association of Events Organisers (AEO)Association of Colleges (AOC)Association of Licenses Multiple Retailers (ALMR)American Society for Industrial Security (ASIS)Association of Town & City Management (ATCM)Rail Delivery Group (ADS) previously ATOCAssociation of University Security Officers (AUCSO)British Bankers Association (BBA)British Security Industry Association (BISA)British Retail Consortium (BRC)Civil Aviation Authority (CAA)Credit Industry Fraud Avoidance Society (CIFAS)Cinema Exhibitors Association (Cinema UK)Chartered Institute of Public Finance and Accounting (CIPFA)Federation of Small Businesses (FSB)Financial Fraud Action UK (FFA UK)Financial Services - Information Sharing and Analysis Centre (FS - ISAC)Freight Transport Association (FTA)Institute of Chartered Engineers (ICE)International Council of Mining & Metals (ICMM)International Security Management Association (ISMA)National Federation of Retail Newsagents (NFRN)Newspaper Publishers Association (NPA)Night Time Industries Association (NTIA)Oil Companies International Marine Forum (OIMF)Race Course Association (RCA)Road Haulage Association (RHA)Royal Institute of Chartered Surveyors (RICS)Security Institute (SI)Security Industry Authority (SIA)National Health Service (NHS)Representative Body for the Technology Industry (TECH UK)Teleoms UK Fraud Forum (TUFF)Worshipful Company of Hackney Cab Drivers (WCHCD)Click in the box to choose any which apply from the listDetails of any other associations etc. not listed aboveDeputy Contact DetailsName* First Last Company / Organisation*Job Title*Brief summary of company / organisation core business*Address* Street Address Address Line 2 City Post Code Telephone Number*Mobile Number*Email Address* Industry Sector InformationSelect the Industry Sector that most applies to your area of business*Food, Beverage and TobaccoMetal, Plastic, and non-Metal Mineral ProductionShipbuilding and Maritime ServicesChemicalsInformation, Communications, Technology and Precision InstrumentsAutomotiveAerospace and DefenceMachinery, Electrical and Transport EquipmentPharmaceuticalAgriculture, Forestry and FishingPetrochemical and MiningUtilitiesConstructionCommunications and MediaDigital and Creative Information ServicesBusiness ServicesFinancial ServicesResearch and DevelopmentEducationHotels, Restaurants and Licensed PremisesRetail and TourismTransport, Storage and DistributionReal Estate and Property Management ServicesAdministrative and Support ServicesSecurityPublic AdministrationDefence ServicesHealth and Social CareCommunity, Faith, Diversity & Personal ServicesCSSC RegionWhich region(s) are most relevant for your representation?*NationalLondonEasternScotlandSouth EastSouth WestWest MidlandsEast MidlandsNorth WestNorth EastWalesNorthern IrelandClick in the box to choose any which apply from the listMessage Cascade InformationAre you willing to cascade messages?*YesNoAre you willing to cascade outside of your own company / organisation?*YesNoAre you willing to accept additional contacts provided by CSSC to your cascade?*YesNoLevel of Message DistributionHow many people will you distribute the message to outside of your company / organisation?*How many people will you distribute the message to within your company / organisation?*How many companies are in your external distribution?*Estimate the percentage of companies within your distribution in the following regionsMain Region*0% - 10%10% - 20%20% - 30%30% - 40%40% - 50%50% - 60%60% - 70%70% - 80%80% - 90%90% - 100%UK but outside of London*0% - 10%10% - 20%20% - 30%30% - 40%40% - 50%50% - 60%60% - 70%70% - 80%80% - 90%90% - 100%International*0% - 10%10% - 20%20% - 30%30% - 40%40% - 50%50% - 60%60% - 70%70% - 80%80% - 90%90% - 100%Are you willing to add a CSSC email address to your a cascade to allow for performance monitoring of the CSSC network?*YesNoAdditional Information to Support Your Application MiscellaneousHow did you hear or find out about CSSC?Attended an event where CSSC was discussedThrough local CTSAWord of mouth from other business leadersDiscovered websiteRead a CSSC brochureOtherConsent for us to contact youI consent for my email address and phone number to be collected by CSSC for the sole purpose of receiving CSSC messaging. I understand that I can withdraw consent at any time by contacting membership@thecssc.comI consent to receiving CSSC alerts via email* Yes I consent to receiving CSSC alerts via text Yes CommentsThis field is for validation purposes and should be left unchanged.
