BLF MEMBERS REGISTRATION FORM
Thank you for taking interest in our Charity. Please use this form to register for access to all our FREE SERVICES. Find more here: www.bassuahlegacy.org/our-services

Health & Wellness Programme
Basic Education Programme
Employment Support Programme
Volunteer Programme
General Support Service

Email *
Name *
Date of Birth *
Please enter the date of birth in this format DD/MM/YYYY eg: 30/09/1990
MM
/
DD
/
YYYY
Phone number *
Address *
Please enter your full address
Post Code *
Please enter your full post code
Ethnicity *
ASIAN: British, Indian, Pakistani, Bangladeshi or Any other Asian background || BLACK: African, British, Caribbean or Any other Black background. || MIXED: White and Black (African, Caribbean or Other), White and (Asian or Other), Black and Asian or Any other Mixed background || ORIENTAL: British, Chinese, Japanese or Any other Oriental background || WHITE: British, Irish, Scottish or Any other White background.
Are you a single parent or from a single parent household? *
Are you currently a single parent or was your parent a single parent?
What best describes your current family structure? *
How many children/dependants do you have? *
What is your current employment status? *
What is your usual household income before tax, including working taxcredits and benefits? *
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