Select Individual membership type (tick 1) 1. Individual who lives in the area2. Individual who works (but does not live) in the Area3. Individual who lives and works in the Area4. Individual who does not live in the Area, but with a material and ongoing interest in the Area (environmental, social, cultural, or economic)5. Elected member of Merton Council, any part of whose area falls within the Area, who shall be ex officio members
First Name
Surname
Postal Address Street Name and Number Town Or City PostCode
Email address
Your telephone number (Optional)
For additional details which will help us ensure that the neighbourhood forum represents all people in the neighbourhood please fill in this information as well.
Which of the following describes how you think of yourself? MaleFemaleIn another wayPrefer not to say / Not applicable
Select Age Bracket 18-2425-3435-4445-5455-6465-7475 and overPrefer not to say / Not applicable
Are you registered disabled? YesNoPrefer not to say / Not applicable
Ethnic origin I would describe myself as (tick 1) White BritishWhite IrishWhite OtherBlack or Black BritishAfricanCaribbeanBlack OtherIndianPakistaniBangladeshiChineseArabMixed: White and Black CaribbeanMixed: White and Black AfricanMixed: White and AsianMixed OtherAny other ethnic groupPrefer not to say
How did you hear about us? (tick 1) Word of mouthSocial mediaResidents' AssociationOther local organisationLove Wimbledon or other business interest groupLocal event / stall in the townPress, radio or televisionDon’t knowOther, (Write in)
Any additional (Optional) information or questions for us?
Privacy Policy Please tick to indicate that you have read and understood the Privacy Policy (opens in a new window) You must do this before proceeding.
Data Protection All information supplied will be held by PlanWimbledon and will remain secure and confidential. This data will only be held and used for the 'legitimate purposes' of PlanWimbledon. The ‘lawful basis’ for this data processing is the ‘explicit consent’ of the member in question. We will use this information to inform members of the activities of the group and to analyse the data for the purposes of submitting an application to become a designated Neighbourhood Forum under UK law.
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