Individual Membership

 

NORTHAMPTONSHIRE RIGHTS AND EQUALITY COUNCIL

 

Join us in supporting Social Justice in Northamptonshire

 

Application for individual Membership 2011/2012

 

I hereby support the formation of Northamptonshire Rights & Equality Council and apply for membership of the new organisation when it is formed as an:

 

  • INDIVIDUAL voting member (for those who live or work in Northamptonshire)

  • ASSOCIATE member (for those who want to support the new organisation, but do not live or work in Northamptonshire)

 

I DECLARE that:

  • I fully subscribe to the aims and objects of the proposed Northamptonshire Rights & Equality Council (i.e. to work towards the elimination of discrimination, to promote equality of opportunity, and promote good relations across diverse communities)

  • I wish to contribute actively to achieve these objectives

  • I understand and accept the responsibilities which may fall on members/associate members

 

 

 

NAME: ___________________________________________

 

ADDRESS: _______________________________________________POST CODE: _________________

 

TELEPHONE (HOME): _________________________ (WORK): _________________________________

 

E-Mail: ______________________________________________________________________________

 

There is no membership fee for NREC at this time. If however you would like to make a donation this would be gratefully received. Please make cheques payable to "NREC".

 

Signed: _________________________________ Date: _________________

 

 

In order for NREC to effectively monitor its equal opportunities policy we would be pleased if you could supply the following information. Please note that this is voluntary, but be guided by the importance we attach to this information. Please note: all information supplied on this form will be stored on our computerised database, in confidence.

 

  • I would describe my ethnic origin as:

White–British

 

Black/British - Caribbean

 

Asian/British - Indian

 

Asian/British - other

 

Dual Heritage/Mixed race (Specify)

 

White–Irish

 

Black/British - African

 

Asian/British - Pakistani

 

Chinese

 

Other Ethnic Group

(Specify below)

 

White–Other

 

Black/British - Other

 

Asian/British - Bangladeshi

 

Gypsy/ Traveller

 

 

 

 

  • I consider that I am disabled. The nature of my disability is: ...........................................

 

  • I would describe my religion as: ................................. (if not religious put "NONE")

 

  • I am aged: ............

 

  • My Gender is: Man/Woman

What is your sexual orientation? Bisexual Gay man

Gay woman/lesbian Heterosexual/straight Other

Prefer not to say

 

 

 

 

PLEASE RETURN THIS APPLICATION FORM TO:

NREC, c/o Northampton College, R Building, Booth Lane, Northampton,NN3 3RF  

 

 

 

Date application received

 

Date Application Approved

 

Computer entry date

 

 

 

 

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