MEMBERSHIP REGISTRATION FORM * Required Field Title*: - Select - Mr Mrs Ms First Name: Surname*: Email Address*: You must provide a valid email address in order to be a network member Contact Number*: This will only be used if we are unable to contact you by email Name of Group: Date Group Established (if applicable): - 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st - January February March April May June July August September October November December - 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 Website: If your group has a website, please provide the full web address DECLARATION*: I understand the following: The information provided above will be held in line with Data Protection and will be used by Leicestershire County Council for Neighbourhood Planning purposes. I will receive information about Neighbourhood Planning and invitations to the Leicestershire Neighbourhood Planning Network Events. Contact information may also be shared with Leicestershire Local Planning Authority Officers. I Agree