Member type	Community Colleagues Young People's Network
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Ethnic Origin	Asian or Asian British Black or Black British Mixed of Multiple Ethnic Origins White Any other ethnic group I prefer not to say
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Do you have any special postal requirements	Large print No email address
Do you have a health problem or disability that limits your day to day activity	No Yes Prefer not to say A sensory disability A physical disability A learning disability Mental health need
How would you like to be involved?	Receive regular news updates and information Receive invitations to member events Join discussion and focus groups Join our Readers Panel to review patient literature Help to recruit new members at community events Take part in colleague recruitment panels Consider standing for election to the Members' Council Become a Locala volunteer
Please select any services that you are interested in	Adult health services Family Health Services GP Practices Wellbeing Services
How are you connected with Locala?	Patient Carer of a patient Previously worked for Locala Student Volunteer
How did you hear about Locala?	At a community event Locala website Through a friend/family member Through a Locala colleague School/College

Member type
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Are you:
Address
County
Postcode
Mobile
Email
Ethnic Origin
Do you consider yourself to be?
Do you identify as:
Do you have any special postal requirements
Preferred method of contact
Do you have a health problem or disability that limits your day to day activity
How would you like to be involved?
Please select any services that you are interested in
How are you connected with Locala?
How did you hear about Locala?

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