Citizens Panel Registration
By completing this from you are agreeing to receive surveys on local issues sent by Bedford Borough Council and for you information to be processed in accordance with the privacy notice at the bottom of each page. Should you wish to be removed from the panel you can email
citizenspanel@bedford.gov.uk
at any time.
First Name
Surname
Contact Address
Postcode
Email Address
Please click 'Next' to continue
Citizens Panel Registration 2018
The following questions are not compulsory, and you are still welcome to join the panel if you choose not to answer them.
Gender
(please tick one box only)
Male
Female
Prefer not to say
If female, are you currently pregnant?
(please tick one box only)
Yes
No
Prefer not to say
Is your present gender the one you were assigned at birth?
(please tick one box only)
Yes
No
Prefer not to say
Age
(please tick one box only)
16 - 17
25 - 34
45 - 54
65 +
18 - 24
35 - 44
55 - 64
Prefer not to say
Please click 'Next' to continue
Citizens Panel Registration 2018
Do you have any of the following conditions?
(please tick all that apply)
A physical disability
Learning difficulties
Prefer not to say
A sensory disability
Any other long term condition
Mental health problems
None of the above
What is your Ethnic Group?
(please tick one box only)
WHITE English / Welsh/ Scottish / Northern Irish / British
MIXED Other
WHITE Irish
ASIAN Indian
WHITE Gypsy or Irish Traveller
ASIAN Pakistani
WHITE Other
ASIAN Bangladeshi
BLACK OR BLACK BRITISH Caribbean
CHINESE
BLACK OR BLACK BRITISH African
ASIAN Other
BLACK OR BLACK BRITISH Other
ARAB
MIXED White & Black Caribbean
OTHER
MIXED White & Black African
Prefer not to say
MIXED White & Asian
Please specify 'other' (please type in)
Please click 'Next' to continue
Citizens Panel Registration 2018
Which of the following best describes your religion/faith or belief?
(please tick one box only)
Buddhist
Jewish
No religion
Christian
Muslim
Other
Hindu
Sikh
Prefer not to say
Please specify 'other'
(please type in)
Which of the following best describes your sexual orientation?
(please tick one box only)
Bisexual
Gay woman / Lesbian
Other
Gay man
Heterosexual / Straight
Prefer not to say
Please click 'Submit' to send us your response
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