Individual Membership Sign Up Form

Network member sign up

Email address

First name

Last name

Where did you hear about signing up for membership?

Interest in co-production

citizen / community member

Student

Volunteer

Professional

Course title and academic institute (if applicable):

Organisation (for your main activity, whether volunteer or professional):

Job title or role:

Which sector are you in?

Public/statutory sector

Third/voluntary sector

Private sector

Area of work (if more than one, please add more in the box below):

Academia and research

Arts, culture and heritage

Children and families

Communities

Consultancy and training

Education

Government (local and national)

Health and mental health

Homelessness and housing

Social care

Sport and well-being

Sustainability and environment

Other area of work

Other/additional area of work

County (Wales only) where you co-produce:

Blaenau Gwent

Bridgend / Pen-y-bont ar Ogwr

Caerphilly / Caerffili

Cardiff / Caerdydd

Carmarthenshire / Sir Gaerfyrddin

Ceredigion

Conwy

Denbighshire / Sir Ddinbych

Flintshire / Sir y Fflint

Gwynedd

Isle of Anglesey / Ynys Môn

Merthyr Tydfil / Merthyr Tudful

Monmouthshire / Sir Fynwy

Neath Port Talbot / Castell-nedd Port Talbot

Newport / Casnewydd

Pembrokeshire / Sir Benfro

Powys

Rhondda Cynon Taf

Swansea / Abertawe

Torfaen / Tor-faen

Vale of Glamorgan / Bro Morgannwg

Wrexham / Wrecsam

If you're not in Wales, which country are you in?

England

Scotland

Northern Ireland

Outside the UK

Country (if outside of UK):

Date of birth:

Are you a Welsh speaker or learner?

Siaradwr Cymraeg (I am a Welsh speaker)

Dysgwr Cymraeg (I am a Welsh learner)

I am not a Welsh speaker or learner

Which of these options best describe your gender?

Male

Female

Prefer to self-describe

Prefer to self-describe (gender):

Which of these options best describes your sexual orientation?

Heterosexual / straight

Gay / lesbian

Bisexual

Prefer to self-describe

Prefer to self-describe (sexual orientation):

Which of these best describes your ethnic background?

Asian, Asian Welsh or Asian British

Black, Black Welsh or Black British

Mixed, Mixed Welsh or Mixed British

White, White Welsh or White British

Other ethnic background

Other ethnic background:

Which of these options best describes your religion or spiritual beliefs?

Agnostic

Atheist

Buddhist

Christian

Hindu

Humanist

Jewish

Muslim

Sikh

Spiritualist

Other religion

No religion

Other religion

Do you have caring responsibilities?

Yes, I have caring responsibilities

No, I do not have caring responsibilities

Do you consider yourself to have a disability?

Yes, I consider myself to have a disability

No, I do not consider myself to have a disability

Rwy'n cytuno i dderbyn eich cylchlythyrau ac yn derbyn y datganiad preifatrwydd data.

Gallwch ddad-danysgrifio unrhyw bryd gan ddefnyddio'r ddolen yn ein cylchlythyr.

Rydym yn defnyddio Brevo fel ein platfform marchnata. Drwy gyflwyno'r ffurflen hon rydych yn cytuno y bydd y data personol a ddarparwyd gennych yn cael ei drosglwyddo i Brevo i'w brosesu yn unol â Pholisi Preifatrwydd Brevo.

Individual membership sign up form

Ein haelodaethau a'n haddewidion

Dros Gymru decach a mwy cynaliadwy lle mae gan bawb lais sy'n cael ei glywed.

Polisi preifatrwydd | Hygyrchedd

Ein haelodaethau a'n haddewidion

Dros Gymru decach a mwy cynaliadwy lle mae gan bawb lais sy'n cael ei glywed.

Polisi preifatrwydd | Hygyrchedd