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

Other/additional area of work

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:

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

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Individual membership sign up form

Our memberships and pledges

For a fairer and more sustainable Wales where everyone has a voice that is heard.

Privacy policy | Accessibility

Our memberships and pledges

For a fairer and more sustainable Wales where everyone has a voice that is heard.

Privacy policy | Accessibility