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Membership Application Form
Please fill this form to sign up to our newsletter and join Empowering Parents Together.
If you do not have an email address or have any issues, please contact us on:
- 07486880799
- info@empoweringparentstogether.org.uk
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* Indicates required question
Email
*
Your answer
Title
*
Miss
Ms
Mrs
Mr
Dr
Other:
First name(s)
*
Your answer
Surname
*
Your answer
Phone
*
Your answer
Address line 1
*
Your answer
Address line 2
Your answer
Town / City / County
Your answer
Postcode
*
Your answer
Preferred method of contact
*
Email
Phone
Text
Post
Other:
Required
Ethnicity
*
Indian
Pakistani
Bangladeshi
Chinese
Other Asian background
Caribbean
African
Other Black, Black British, or Caribbean background
White and Black Caribbean
White and Black African
White and Asian
Other mixed or multiple ethnic background
White - English, Welsh, Scottish, Northern Irish or British
White - Irish
White - Gypsy or Irish Traveller
White - Roma
Other White background
Arab
Other ethnic group
Prefer not to say
Gender
*
Female
Male
Other
Prefer not to say
Are you registered disabled?
*
Yes
No
Prefer not to say
How did you hear about us?
*
Children's centre
Facebook
GP
Redbridge Child Development Centre (The Grove)
Redbridge Therapy Services
School
Social Worker
Word of mouth
Other:
Membership level - tick all that apply
*
Parent / Carer
Associate (professional)
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