New Member Registration

If you would like to join WOW, please complete the following registration form ensuring all sections have been completed, and then submit this form (Membership is FREE):

* Indicates required field

Step 1 Contact Details

I am applying as an: Individual Organisation
Please note that organisations joining WoW will receive FREE publicity on our website www.wowonline.org.uk

Organisation’s Full Name (if applicable):

* Full Name:

Position (if applicable):

* Your Address:

* Postcode:

* Phone Number:

* Email Address:

Website Address:

Would you like us to include your organisation’s details on our website?

Please tell us which WoW services you are interested in using. Tick all that apply:

Free publicity on the WoW Website
Newsletters
Networking opportunities
Distribution of information
Workshops
Other

What would you like to gain from joining WoW?

Can we approach you for consultation on strategies and policies? Yes No

Privacy Statement*

WoW respects the privacy of individuals and recognises that organisations often need to keep information confidential. Please ensure that you have indicated in Step1 if there are any contact details you wish to remain confidential. We are often asked to refer people to other organisations, if you would prefer that we do not do this, please tick this box

Step 2 Membership Agreement Statement (WoW Membership is FREE)*

I support the mission and aims of Women Organising in Wolverhampton and wish to apply for membership. The information provided in this form is correct to the best of my knowledge.

Step 3 Data Protection

The Data Protection Act(s) covers any personal information you willingly provide on this page. All of the information will be kept confidential and will only be used for the required purpose. You have the right to see the information we hold about you.

Equal Opportunities Monitoring Form (If applying as an organisation – please complete for main contact only)

Gender: Male Female

Ethnicity:

White
- Any White background
Asian
- Bangladeshi
- Indian
- Pakistani
- Any other Asian
Black
- African
- Caribbean
- Any other Black background
Chinese
- Any Chinese background
Mixed Ethnic Background
- Asian and White
- Black African and White
- Black Caribbean and White
- Any other Mixed background
Any other ethnic group
- Any other ethnic group
Refuse to disclose

Age:
Which of the following age groups do you belong to?
17 years and under 18 - 24 25 - 29 30 - 44 45- 59 60 - 64 65 +

Disability:
The Disability Discrimination Act (2005) defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term adverse effect on their ability to carry out normal day-to-day activities.
Do you consider yourself to have any disability? Yes No
Are you registered disabled? Yes No

Alternatively, download the PDF application form, print, complete and send to Women Organising in Wolverhampton, PO Box 105, Wolverhampton WV1 4LP.