Equality, Diversity and Inclusion Group Membership Form
Name
*
First/Personal Name
Last/Family Name
Affiliation
*
Name of Institute
Email
*
example@example.com
Would you like to be considered for a leadership role within the group?
Yes
No
We will keep these details on file in order to contact you about the EDI group's work. Please confirm that you are happy to receive this information from us. We do not share this information outside the organisation and you can unsubscribe at any time.
*
Yes, I confirm that I give my permission to be contacted.
No, I do not give my permission.
Submit
Should be Empty: