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Changes Bristol Membership Form
Thank you for choosing to join the Changes Bristol Support Network. There is just 1 quick step to becoming a member: fill out the Membership Form below! After filling it you will then receive an email from our team within a few days which explains a few things. You will be signed up to receive our weekly links for online groups that Friday.One of our team will then give you a welcome call within the next week or so to tell you a little more about the support groups and check in with you. If you miss this call, don't worry, you can still access everything, but if you miss it and would still like to speak to us, give us a call on 0117 941 1123.Membership gives you access to all areas of Changes Bristol's organisation including all support groups (online and in the community) and any other activities. Please note telephone befriending is a Bristol service only. Any data collected is for our own information only and will not be shared with third parties. You have a right to request to see the data we hold on you, and to ask for it to be deleted at any time.If you have any issues or questions please ring 0117 941 1123 or email info@changesbristol.org.uk
Contact Details
Email*
Our groups are for anyone aged 18 or over. Please confirm you are over 18:*
First Name*
Last Name*
Phone Number*
Date of Birth*
What type of support are you interested in?
Address line 1
Address line 2
City
Postcode*
How did you hear about Changes Bristol?
If you answered "other support service / charity" above, please let us know which one:
Mental Health
Have you had a diagnosis from a healthcare professional?
Contact Preferences
We would like to send you our monthly e-newsletter which includes news about mental wellbeing, our services and ways to get involved. Please tick here to confirm
Occasionally we send out emails in relation to the following specific areas of the charity. Please select any that you would like to hear about:
Fundraising
Training / Courses
Volunteering
Would you like to be a voting member? This means you would be able to influence how the organization is run and be able to vote in the AGM each year
Personal Details
Please choose your age bracket:
How would you describe your gender?
Is your gender identity the same as the sex you were assigned at birth?
Do you identify as transgender?
Pronoun
Ethnicity
If your ethnicity was not listed, please describe in your own words
Main Language
Main Language - Other:
Sexual Orientation
Religion / Belief
If your religion/belief was not listed above, please describe
Do you consider yourself to have a disability related to your mental health?
Do you consider yourself to have a sensory, learning or physical disability?
Have you personally used mental health services?
How would you describe your mental health difficulties?
Marital Status
Are you pregnant?
Employment Status
Caring responsibility: do you look after a child?
Caring responsibility: do you look after an adult?
Caring responsibility: do you look after someone with a sensory, learning or physical disability?
Caring responsibility: do you look after someone with a disability related to their mental health?
[Date of submission]