BECOME A MEMBER MEMBERSHIP FORM If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required The Grand Union Village Community Trust has been set up to bring residents, businesses, community groups and service providers together to work collectively for the benefit of the Village under the following vision statement: To create a sustainable and inclusive community for those living and working in the Village and surrounding areas, through supporting economic, recreational and environmental initiatives. Membership is free and open to every resident and business within the village and to community organisations around the Village. It will provide you with an opportunity to have your say in what the Trust does, to receive information on events run by the CDT and the community facilities, as well as a vote at the AGM for your Resident Trustees on the Board. First Name * Last Name * Organisation / Business (if any) * Address * Postcode * Email * Phone Date of birth (if under 16) It would help the Trust to understand the members needs further if you could complete as much of the monitoring information below as possible. You do not have to provide all of the details in this section, but please complete as much as you feel able to, to assist us in providing statistical information to our funders. Age group Under 1617 - 2526 - 3536 - 4546 - 6061+Do not wish to answer Do you have a disability? YesNoDo not wish to answer Gender MaleFemaleDo not wish to answer Ethnic Origin White BritishWhite IrishWhite - otherAsian BritishAsian - PakistaniAsian - IndianAsian - BangladeshiAsian - otherBlack BritishBlack CaribbeanBlack - otherMixed / Other Employment EmployedSelf employedUnemployedRetiredUnwagedStudent Membership category * OwnerTenantLocal businessOrganisation People in your household (please specify the number of adults and children) What is thirteen minus 6? * Grand Union Village Community Development Trust is registered under the Data Protection Act and will not pass on your details to any third party without your permission.