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* 1. Name

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* 2. Address

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* 3. Post Code

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* 4. Date of Brith

Date

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* 5. Email Address

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* 6. Mobile Number

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* 7. In the event of an emergency  name of the person to be contacted

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* 8. Emergency Phone Number

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* 9. Are you in Employment 

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* 10. What type of housing do you live in?  Please tick a box

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* 11. Is your household income below £25,000

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* 12. Are you in receipt of benefit?

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* 13. Please select all that applies

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* 14. Please tell us what interest you have and how Thrive can help?

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* 15. Do you already have a business?

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* 16. If yes What is the name of your Business

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* 17. Business Website

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* 18. Business Email Address

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* 19. Please select your Thrive Annual Membership Package

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* 20. Please select your Pre- Paid Thrive User Package

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* 21. How Did You Hear About Thrive? 

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* 22. What is your Gender?

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* 23. What is your Ethnicity? Please tick a box

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* 24. What is your Sexual Orientation? Please tick a box

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* 25. What is your religion? Please tick a box

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* 26. Do you have a disability? Please tick a box

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* 27. Do you  have any further comments?

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* 28. Self-Declaration: 
 
I declare that the information I have given is correct, to the best of my knowledge. 
 
 
Privacy Notice – How We Use Your Personal Information  
  
This privacy notice is issued by Tree Shepherd Limited.  It is to inform Thrive Members how their personal information will be used by Tree Shepherd Limited and British Land PLC.  For the purposes of relevant data protection legislation, Tree Shepherd Limited is the data controller for personal data processed 
  
The information supplied on this form will be retained securely by Tree Shepherd Limited and British Land PLC 
  
The personal information provided is used by Tree Shepherd Limited and British Land to create a personal business recorded within Tree Shepherd’s secure dataset.  The information is used to support your membership at Thrive and for the provision of ongoing business support.  The data may also be used for data analysis and research.  This is to ensure the provision of high quality, inclusive, relevant service which supports achievement and progression, regardless of individual background, skills, knowledge, experience and support needs. 
  
The information provided may be shared in anonymised form with third parties for businesses, training, (self) employment and well-being related purposes including for research.  You will not be individually identified without prior consent. Your information will be securely destroyed after it is no longer required for these purposes. 
  
At all times, sharing of your information will only take place where the law allows it and the sharing is in compliance with data protection legislation.  You may change your preferences at any time. 
  
Tree Shepherd Limited and British Land PLC may use your contact details to let you know about business development opportunities, including clinics, events, trading, networking and business support opportunities and British Land PLC/Canada Water Masterplan 
 
You can agree to be contacted for these purposes by ticking any of the following boxes (you may tick multiple boxes): 
 
□ About opportunities in support of business development 
 
□ For surveys and research 
 
□ By email  
 
□ By phone 
 
□ By post 
 
□ By text messaging 
 
Declaration:  
 
I confirm that the information that I have provided is correct to the best of my knowledge and authorise Tree Shepherd and British Land to use my information for the above purposes. Your information will be securely destroyed after it is no longer required for these purposes.  
I have read and agree to abide by the THRIVE Membership Agreement, Terms & Conditions, and Fire Emergency Procedures (these documents are available at THRIVE reception and posted on the bulletin board; members may request a copy for their records).  
 
Please note that your annual membership will become active once you have made your membership payment.  Annual Membership fees are non – refundable.

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* 29. Further information about our data protection policy and procedures, including use of and access to your personal data are available at: info@treeshepherd.org.uk

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* 30. There are occasions when photographs of activities are taken for publicity and marketing purposes, and you can agree for your image to be taken by ticking the following box: □

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