Please tick boxes YES or NO. All questions in this first section must be answered.

Do you live in the village?  YES NO

Do you work in the Village? YES NO

I would like to help practically with questionnaires, interviews or  YES NO
research into this community – history, statistics, demographics
and community characteristics

I would like to help with distribution/collection of questionnaires  YES NO

I would like to be a member of the Steering Committee  YES NO

I would like to help the Steering Committee as part of  YES NO
a Working Group

In order to complete the Plan, we will need lots of people with a range of knowledge and skills. Please let us know if you would be prepared to offer any of the following – don’t worry if you’re not experienced, just let us know where you can help.

If you feel you can help in any of the areas listed below,
please tick the appropriate box(s).

Local knowledge  YES
Secretarial  YES
Book keeping  YES
Computers/graphics/data inputting/publishing  YES
Organising events  YES
Catering  
Publicity/media contacts  YES
First aid  YES
Interviewing/meeting people  YES

Any other – please specify

About you

Please fill in the fields below. All questions in this section must be answered.

Your name    

Your year of birth e.g. 1970    

In compliance with the Data Protection Act, I give permission for my contact
details to be kept on a community database for internal use only.

 I accept the terms (please tick the box).

Please type the characters below in the box.
    

Before pressing SUBMIT please tick the box