Muslim Women Network UK

4 Edward Street
Birmingham
B1 2RX

Tel 1: 0121 236 9000

Fax: 0121 236 9001

Membership Registration Form

Note: Individuals can apply - you do not have to be a part of an organisation.

What best describes you or your organisation
		An individual interested in Muslim women’s issues
		An individual actively working with Muslim women
		An organisation with an interest in Muslim women
		An organisation actively working with Muslim women
		Government official working with a remit for progressing work on Muslim Women
		An elected politician

Do you or your organisation operate locally, or regionally or nationally?

Please indicate which one applies to you?
		In education (Please state whether pre-16; post 16; undergraduate; graduate; or post graduate)
		Housewife
		Private Sector
		Voluntary Sector
		Academic
		Political Representative
		Government Official (Please state whether local, regional or national)
		Other (Please specify)

What are your (or your organisation’s) areas of interest or expertise. Please include details about any of your work, skills, experiences and professional qualifications that you think are relevant.

Approximately how many women do you think you can reach.
		Upto 10
		Up to 50
		Up to 100
		Up to 250
		Up to 500
		Or state how many

As a member of MWN-UK, please tell us what you are interested in. You may tick more than one option.
		Receiving regular newsletters and / or information
		Attending workshops
		Attending occasional member events
		Acting as a mentor
		Helping with training / sharing skills
		Voluteering (e.g if we organise local events / consultations)
		Being involved on the steering group (Note: numbers on the steering group will need to be restricted for practicality)

Which, if any, of your details can we make publicly available e.g. put on our website?

How did you hear about us?

*What is you ethnic background?

*What is your religion, if any? (non-Muslim women who work with Muslim women may also apply)

I agree to objectives outlined in the MWN-UK terms of reference.
Name		Date:

Security Verification:

*these questions are asked for monitoring purposes only.

Note: MWN-UK has the right to refuse or revoke membership. Also attendance at meetings may be limited for reasons of practicality

Please return the application forms to the address below. If you e-mail applications, please also put a copy in the post.

MWN-UK, P.O. Box 12637, Birmingham, B28 1AH. Telephone: 0870 626 3786 Fax: 08712 775 704
E-mail: contact@mwnuk.co.uk Website: www.mwnuk.co.uk

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