Organisation Membership 2011 - 2012 |
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- Created on Saturday, 02 April 2011 11:13
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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 say "NONE")
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I am aged: .............
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My Gender is: Man/Woman
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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 say "NONE").
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I am aged: .............
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My Gender is: Man/Woman
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Date application received
Date Application Approved
Computer entry
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NORTHAMPTONSHIRE RIGHTS & EQUALITY COUNCIL
Join us in working for Social Justice
Application for Organisation Membership 2011/2012
We, ………………………………………………………………………………(NAME OF ORGANISATION), AGREED AT A MEETING HELD ON ..…………(DATE) to apply for membership of the proposed Northamptonshire Rights & Equality Council, and authorised the undersigned to make an application on our behalf. We fully support the aims and objects of the proposed Northamptonshire Racial Equality Council (i.e. to work towards the elimination of racial discrimination, to promote equality of opportunity, and to promote good race relations between persons of different racial groups).
We further affirm our desire to fully-co-operate with others in the achievement of these objectives.
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: …………………………...................
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NAME OF SECRETARY/MAIN CONTACT PERSON:______________________________________________________
ADDRESS: _______________________________________________POST CODE _____________
TEL (HOME)______________________E-Mail______________________________________________________ |
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Our two representatives to serve as members of NREC will be:
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1. REPRESENTATIVE'S NAME: ___________________________________________________________________
ADDRESS _______________________________________________________POST CODE _________________
TEL (HOME) __________________(WORK) ___________________E-Mail _______________________________ |
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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) |
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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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2. REPRESENTATIVE'S NAME: ___________________________________________________________________
ADDRESS _______________________________________________________POST CODE _________________
TEL (HOME) __________________ (WORK) ___________________ E-Mail ______________________________
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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) |
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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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Please note: all information supplied on this form will be stored on our computerised database, in confidence
PLEASE RETURN THIS APPLICATION FORM TO: Northamptonshire Rights & Equality Council, c/o Northampton College, R Building Booth Lane, Northampton NN3 3 RF
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