Join Us - Registration Form

Customer Details:
Title

MissMrsMsMrMx
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Date of Birth*

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Address*

Street Address

Address

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What best describes your ethnicity?*

White: English/Welsh/Scottish/Northern IrishWhite: IrishWhite: Gypsy or Irish TravellerWhite: OtherArabMixed: White and Black CaribbeanMixed: White and Black AfricanMixed: Other/multiple ethnic backgroundsAsian or Asian British: IndianAsian or Asian British: PakistaniAsian or Asian British: BangladeshiAsian or Asian British: ChineseAsian or Asian British: OtherBlack or Black British: AfricanBlack or Black British: CaribbeanPrefer not to sayOther
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E-mail*
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Job title*
Name of employer*
Address of employer*
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Employees United holds personal information about its members. This is used to provide members with the benefits and services to which they are entitled under Employees United rules, and provide information about other benefits and services which may be of interest. It may be used for statistical or other purposes relating to administration of the Union.*

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