Individual Membership |
- Details
- Created on Saturday, 02 April 2011 12:26
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INDIVIDUAL voting member (for those who live or work in Northamptonshire)
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ASSOCIATE member (for those who want to support the new organisation, but do not live or work in Northamptonshire)
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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)
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I wish to contribute actively to achieve these objectives
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I understand and accept the responsibilities which may fall on members/associate members
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I would describe my ethnic origin as:
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I consider that I am disabled. The nature of my disability is: ...........................................
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I would describe my religion as: ................................. (if not religious put "NONE")
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I am aged: ............
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My Gender is: Man/Woman
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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:
I DECLARE that:
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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.
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White–British |
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Black/British - Caribbean |
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Asian/British - Indian |
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Asian/British - other |
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Dual Heritage/Mixed race (Specify) |
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White–Irish |
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Black/British - African |
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Asian/British - Pakistani |
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Chinese |
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Other Ethnic Group (Specify below) |
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White–Other |
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Black/British - Other |
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Asian/British - Bangladeshi |
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Gypsy/ Traveller |
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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
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Date application received |
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Date Application Approved |
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Computer entry date |
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