UiD - Member Registration Form
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How did you hear about the Unity in Diversity Group? Personal Details Equal Opportunities Surname:* Title: Forename/s:* Home Address:* Postcode: NI Number:* Contact Number:* Gender:* (please tick) (please tick) Disability: Date of Birth:* DD/MM/YY (Questions marked * are required) Female Rather not say No Y es Rather not say Male Yes/No The United Reformed Church 39 Convent Street Swansea - SA1 2BX Contact: [email protected] Me m ber R egistrati on Form Email: Are you getting any money from the Government? (please tick) Are you: community member asylum seeker refugee
description
It is very helpful to us if a registration form is completed and submitted when arriving at UiD.
Transcript of UiD - Member Registration Form
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How did you hear about the Unity in Diversity Group?
Personal Details
Equal Opportunities
Surname:* Title:
Forename/s:*
Home Address:*
Postcode:
NI Number:*
Contact Number:*
Gender:*(please tick)
(please tick)
Disability:
Date of Birth:* DD/MM/YY
(Questions marked * are required)
Female Rathernot say
NoYes Rathernot say
Male
Yes/No
The United Reformed Church39 Convent StreetSwansea - SA1 2BX
Contact: [email protected]
Member Registration Form
Email:
Are you getting any money from the Government?
(please tick)
Are you: community member asylum seeker refugee
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How would you describe yourself?Choose ONE section from A to E, and then tick the appropriate box
Declaration:
When you sign this form you agree that we can share your information with The Big Lottery, which provides money for our activities. Well keep your informaton safe in line with the Data Protection Act 1998.
Prefer not to say
BritishEnglishIrishScottishWelshAny other White background, please write in box
Asian or Asian British
Black or Black British
Chinese or other ethnic group
Mixed Heritage
White
White and AsianWhite and Black AfricanWhite and Black CaribbeanAny other Mixed background, please write in box
ChineseAny other, please write in box
AfricanCaribbeanAny other Black background, please write in box
A
B
C
D
E
F
BangladeshiIndianPakistaniAny other Asian background, please write in box
Participant Signature:* Date:* DD/MM/YY
Date:* DD/MM/YYStaff Signature:*
Staff Use Only
