Uid member registration form

Page 1

The United Reformed Church (Carmarthen Rd) Caepistyll Street, Swansea. SA1 2BE Contact: unityswansea@gmail.com Web: www.uidswansea.wordpress.com

Member Registration Form Personal Details Title:

First Name: Family Name: Home Address:* Postcode:

Email:

Telephone Number: Where are you from?

Are you getting any money from the Government? Are you: community member

Yes/No

asylum seeker

(please tick)

How did you hear about the Unity in Diversity Group?

Date of Birth:*

Gender:* Male/Female

Member Signature:

NI Number:*

Disability:

Yes / No

Date:

refugee


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