East Boldon Neighbourhood Forum - Application for Membership
Please fill in the information below to apply for membership which is open to anyone over the age of 16 who lives or works in the Forum area or is an elected Councillor of the Cleadon / East Boldon or West Boldon / Boldon Colliery wards.
Sign in to Google to save your progress. Learn more
Title *
Given Name *
Surname *
Email *
Postcode *
House Number and Street Name *
Phone number
Membership Type *
Please select all that apply
Required
If you work in the Forum area please provide your place of employment
Declaration of any potential conflicts of interest
Members have a duty and are required to declare in advance any financial, party political, employment, land ownership or other interest that has a bearing on the work of the Forum in general or on an agenda item in particular.
Please provide the following demographic information
Our privacy policy is available on our website. The information you provide here is used to show that forum membership is representative of the overall demographic of those living in the forum area. Identifiable details will not be shared with anyone.
Age *
Gender *
Ethnic Origin *
Do you consider yourself to have a disability *
Date of application *
MM
/
DD
/
YYYY
Confirmation that you consent to us holding your data *
Required
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.