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How would you describe your ethnic origin?	Not stated White - English, Welsh, Scottish, Northern Irish, British White - Irish White - Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Mixed Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Asian or Asian British - Other Asian Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Black Do not wish to disclose Other Ethnic Group - Arab Other Ethnic Group - Any Other Ethnic Group

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How would you like to be involved at the current time?	Level 1 Membership (Limited involvement) Level 2 Membership (Active involvement) Level 3 Membership (Full involvement)
Do you have any areas of interest in the services we provide?	Adult Services Children's Services Rehabilitation Services Dental Services Learning Disabilities Services Other Volunteering
Did a member of staff recommend that you become a member?	A carer of someone who is a patient A patient Have worked for Trust Member of BCP Member of DWMH No Yes; If so please give their name and job title in the space provided. Student with Trust

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Country	UK
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How would you describe your ethnic origin?
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How would you like to be involved at the current time?
Do you have any areas of interest in the services we provide?
Did a member of staff recommend that you become a member?

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