Connect Up! - Registration
This 6 week introductory course helps learners develop the fundamentals skills needed to participate and communicate safely online.
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Referrer Details
Please only fill in your details if you are registering on behalf of someone else.
Your Name
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First Name
Last Name
Your Phone Number
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Your organisation
Your Email
example@example.com
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Dates
Which location would you like to register for? Please pick any / all that apply.
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Wellness Centre/ Croydon BME Forum - commencing Thursday 9th June at 2.00-4.00pm
Anerley Town Hall - commencing Thursday 8th June at 2.00-4.00pm
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Attendee details
Name
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First Name
Last Name
Phone Number
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Email
example@example.com
Post Code
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Street Address
Street Address Line 2
City
State / Province
Post Code
Borough
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Please Select
Bromley
Croydon
Lambeth
Southwark
Wandsworth
Sutton
Lewisham
Hackney
Westminster
Hammersmith
Camden
Islington
Other
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Equality and Diversity Monitoring
Age Group
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16-25
26-35
36-45
46-55
56-65
66-75
76+
Prefer not to say
Ethnicity
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White
Mixed or Multiple ethnic groups
Asian or Asian British
Black, African, Caribbean or Black British
Other Ethnic Group
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White
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English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Any other White background
Mixed or Multiple ethnic groups
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White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or Multiple ethnic background
Asian or Asian British
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Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Black, African, Caribbean or Black British
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African
Caribbean
Any other Black, African or Caribbean background
Other ethnic group
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Arab
Any other ethnic group
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