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Become a Member

Name
Username
Email
Date of birth (dd/mm/yyyy)
Do you live, work or study in Luton?	Yes
	No
I agree to abide by BME PROUD’s Conditions of Membership (please tick)

Please help us to improve our service by completing the following equality monitoring information. It will be recorded separately to any personal information and only used for statistical purposes. What’s it got to do with us? This guide will tell you.

Your age
16-24	25-34	35-44	45-54
55-64	65+

Do you consider yourself to have a disability according to the terms given in the DDA?
Under The Equality Act 2010, a person is disabled if they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities, which would include things like using a telephone, reading a book or using public transport.

Yes

Your gender

Male		Female		Trans Male		Trans Female
Other, please write in

Your religion or belief (please tick appropriate box)

No religion	Baha’i	Buddhism	Christianity	Hinduism
Islam	Jainism	Judaism	Sikhism
Other, please write in

Your sexual orientation

Bisexual	Gay man	Gay woman/Lesbian
Heterosexual	Prefer not to say
Other, please write in

Your ethnic group
These are based on the 2001 Census categories and are listed alphabetically below. Please choose ONE section from A to E then tick or write in the appropriate box to indicate your ethnic background

A. Asian, Asian British, Asian English, Asian Scottish or Asian Welsh

Bangladeshi		Indian		Pakistani
Any other Asian background, please write in

B. Black, Black British, Black English, Black Scottish or Black Welsh

African		Caribbean
Any other Black background, please write in

C. Chinese, Chinese British, Chinese English, Chinese Welsh or other ethnic group

Chinese
Any other Chinese background, please write in

D. Mixed

White & Black African		White & Black Caribbean
Any other Mixed background, please write in

D. White

British	English	Irish
Scottish	Welsh
Any other White background, please write in

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