MESMAC MEMBERSHIP APPLICATION FORM
All information given to the organisation will be kept on a secure database and is subject to protection according to the terms of the Data Protection Act. All members will be at liberty to withhold any information they do not wish to disclose. The database will be for the exclusive use of the organisation and will not be disclosed to any parties outside of Yorkshire MESMAC.
Name
Date of Birth
Address
Telephone
Contact Email
FOR WHICH TYPE OF MEMBERSHIP ARE YOU APPLYING?
Full membership is open to Gay men, Bisexual men and men who have sex with men from the Yorkshire area. Associate membership is open to anyone interested in the scheme.
Full Associate
HOW WOULD YOU DESCRIBE YOUR GENDER?
Male Female Other ( Please Specify )
HOW WOULD YOU DESCRIBE YOUR SEXUALITY?
Gay Bisexual Heterosexual Other ( Please Specify )
HOW WOULD YOU DESCRIBE YOUR ETHNIC GROUP?
Asian/Asian British Indian Pakistani Other ( Please Specify )
Black/Black British Caribbean African Other ( Please Specify )
Chinese/Oriental Other ( Please Specify )
White Irish English Scottish Welsh Other ( Please Specify )
Mixed ( Please Specify )
Other ( Please Specify )
Membership forms are available by post from Yorkshire MESMAC, PO Box 417, Leeds LS1 5PN .
If you would like further information about the membership scheme please e-mail here or telephone 0113 244 4209.
Yorkshire MESMAC reserves the right to decline any application for membership to the scheme. Registered Charity No 1040407 Limited Company Reg No 2958336
