Please fill-in our short survey to take part in our regular Club Cuppa Zoom sessions!

This project was made possible thanks to grant funding. As a requirement for that funding, we need to collect demographical information who who took part, in-order for us to anonymously report about the success of the project.

Please note, the next Club Cuppa Session is to take place at 11am on Monday 16th November 2020.

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* 1. Please state your name

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* 2. Please state your email address

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* 3. Please state your Date of Birth

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* 4. Which bracket does your age fall into?

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* 5. Please state your postcode

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* 6. Which of these best describes your gender identity?

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* 7. Which of these best describes how you think of yourself?

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* 8. Which of the following best describes your ethnic group or backgroun?

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* 9. Do you have any physical or mental health conditions/illnesses lasting or expected to last for 12 months or more? 

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* 10. Would you like a FREE Stevenage FC Mug as a welcome gift for taking part in the Club Cuppa sessions?

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* 11. If so, please provide your full address so we can send it out to you:

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