Membership Application Form

Some parts of this form are mandatory (marked *) such as your name and the declaration section. 

All other sections are completely voluntary

Name *      Rank/Grade     Payroll No *   

OCU/Dept. 

 

 

Mailing Address

  

Mobile Phone

Post Code

   Home Phone

     

Mail to this address ? *    

   Work Phone
       

How do we contact you ?

     e-mail address

Mobile Home Phone e-mail WMP e-mail

 

How do you identify yourself ? *        

  

If LGB - Are you Out ? *

  

 
   
What is your birth gender     
   

If you said 'Other' - please specify -

 
       

Is your gender identity the same as the gender you were assigned at birth?

    
     

Do you live and work full time in the gender role opposite to that assigned at birth?

    
   
Do you feel able to discuss your gender identity with colleagues at work?  
   
How did you hear about Rainbow Network ? (tick all that apply)    
Posters      Word of Mouth      Pens/coasters/mousemats       Intranet       Know a member
Police Diary       Found Internet Site   
 

This information is held for administrative purposes on a secure database and details will not be disclosed without your permission - see below declaration
   
I Confirm that I             for my details to be disclosed to other forum members
 

Use this box to send us a message or comment -

Published and maintained by WMP LGBT Forum.
Copyright © 2011 [Rainbow Network]. All rights reserved.
Last revised: 07-01-2011.