Grassroots Westcliff Membership Form

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Please fill in your details below. Grassroots Westcliff require your personal details for the following purposes:

Maintain an accurate membership list
Communicate information and share important documents (eg by email, What's App etc)
Provide appropriate safeguarding care
Plan localised support based on council ward

You will be added to our What's App group and you should receive a "Welcome Pack" email from us within 7 days of signing this form to explain more about our group and ways you can get involved.

First name *

Last name *

Phone number *

Email address *

Address (street and door number) *

Your full postcode *

Which council ward do you live in? *

How did you hear about us? *

Social media (Facebook, Instagram etc)

Received a flyer

Through another local group

Word of mouth (friend, neighbour etc)

Saw a poster

Other:

Required

I consent to Grassroots Westcliff using my information for the purposes outlined above *

Yes

Required

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