SNVB Larder Member Registration
SNVB Larder Member Registration Form
Your Contact Details
First Name
*
Last Name
*
Address Line 1
*
Address Line 2
Town
*
County
Postcode
*
Telephone Number
*
Email
*
About you
Occupation
Employment Status
Employed
I'd rather not say
Retired
Self employed
Unemployed
Are you in receipt of benefits?
Yes
No
Prefer not to say
Number of adults in your household (over 17)
Number of children in your household (under 18)
Food allergies or intolerances
Local larder
Towcester
Roade
Session attendance and delivery requirements
I will attend the Larder session so that I can select my own products
I am immobile and unable to attend a session. Please contact me to arrange delivery (I accept that products will be selected on my behalf)
Where did you hear about the community larder?
Leaflet drop
Local knowledge
Local Media (Newspaper, Magazine, Radio)
Other
Passing by
Social media
Website
Word of mouth
How will being a member of the Community Larder help you?
Access to food
Make money go further
Meet new people
Save food from waste
Age group
18 - 25
26 - 40
41 - 55
56 - 70
71 - 85
86 plus
Ethnicity
Asian/Asian British
Black British
Mixed/Multiple background
Other Asian background
Other background
Other Black background
Other White background
White British
Do you consider anyone in your household to have a physical or mental health disability?
Yes
No
Is anyone in the household 65 or above?
Yes
No
Consent
*
I agree to snvb contacting me to send relevant information about Larder activities and other news and information about snvb projects.
Captcha
Submit
If you are human, leave this field blank.
Powered by
