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* 1. Name:

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* 2. Date of birth:

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* 3. Email address:

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* 4. Contact number:

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* 5. Address:

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* 6. Which of the following best describes your current occupation?

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* 7.  What do you hope to gain from the Melting Pot initiative?

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* 8. What qualities do you think you will bring to the group?

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* 9. The project runs from 6-9pm @ JW3 on the following days. Please indicate your availability for each:

  Available  Unavailable
Wednesday 17th October 2018
Wednesday 14th November 2018
Wednesday 28th November 2018

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* 10. Please tell us about any food allergies or dietary requirements that you have. (The meal will be fully Kosher)

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* 11. Photo Consent
JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website.

Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes.

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* 12. Photo Consent
JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website.

Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes.

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* 13. Photo Consent
JW3 and sponsors would like to document this project for promotional purposes. These images may be sent out to the media with a press release, used for publications or on our website.

Please let us know if you are happy for us to take your photos during the event and use these photos for publicity purposes.

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* 14. Data Protection
JW3 will use the information disclosed in relation to this event only, in the instance we may need to contact you about your place on the project. For example, if you miss a session or have a specific dietary requirement we need clarification on.
 
We will not share your information with any third party organisations or use your details for anything not related to this project.

We would like to keep you informed about other activities for your age group at JW3. Please tick the relevant boxes you would like to receive information about:

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* 15. Declaration

I declare that I am aged 18 or over and that all information stated is true and correct at the time of completion.

Thank you for taking the time to apply for this project. Applicants will be updated on their application progress in late September 2018.

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