East Midlands Open Minds - Online Membership Form

Membership Form

People who come to the club may have joined us at a vulnerable time in their lives. Our aim is to provide a comfortable and relaxed environment amongst like-minded people, where members can socialise and participate casually with friends. Although we encourage social interaction, East Midlands Open Minds do not consent to being used as a dating club, and bears no responsibility for individuals actions. Members should acknowledge other members’ sensitivities and be responsible for their own actions. In order to provide the best possible services for our members we require personal information and general interest information so that we are able to address members needs as much as possible. Thank You.

All information will be confidential

Name*:
Address:
Town
Postcode
Date of birth:	DD /MM/YYYY
Telephone*:
E-mail address:
Next of kin or person to contact and phone number:
Special dietary needs:
Allergies you may want us to be aware of:
Needs you may require support for:
Mobility restrictions:
Activities and Interests you would like to pursue within the group:

* required