Touching Base Network
Personal Details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Borough do you live in?
*
Ethnicity
*
Date of Birth
*
Age
*
Mental Health
Heath & Well-being
Would you like to join as a member for free?
*
Yes
No
If other, please state
What do you aim to achieve joining the TBN as a member?
*
Are you...
*
Single
Married
Divorced
Prefer not to say
Can you read and write fluently?
*
Yes
No
Personal Circumstance
Do you have children?
*
Yes
No
If yes, how many?
Are you Single parenting?
*
Yes
No
N/A
Are you Co-parenting?
*
Yes
No
N/A
Do you have access/able to see your children?
*
Yes
No
N/A
Job & Career
Are you...
*
Working
Unemployed
Business owner
Other
What industry do you work in?
*
Retail
Construction
Management
Administration
Other
If other, please state
Do you work for the...
*
Private sector
Public sector
Other
Free TBN Membership
Would you like to become a member of TBN CIC (membership is currently free until 2025 this includes access to our monthly newsletter, free entry to our bi-monthly events or seminars (that are two hours or less) if you live in the East London
Yes
No
Services & Events
Would you be interested in the following? (Select all that are relevant)
*
Social activities
Sport activitites
Health and well being opportunities
Business opportunities
Personal Development goals
Career progression
Other
Other
Is the anything else you would like to add?
Disclaimer
You will automatically be added to our mailing list. We promise not to spam your inbox, but if you'd like to opt out of this, please email Touchingbasenetwork.cic@gmail.com.*
*
I understand
Submit
Should be Empty: