MEMBER REGISTRATION FORM

Hi and thanks for wanting to join this unique, shiny new Co-op.

I think it's worth saying up front I think this is an exciting project, breaking new territory (well, as far as the research industry goes) that's going to be a fun, roller coaster ride! Together we've got a chance to change how businesses and government engage with ordinary people (us). And in a way that both sides win.

You'll get your say to help organisations (from commercial and government sectors) with some of your great ideas, and your community with some much needed cash. And because we are a Co-op, owned and run by the community we serve, we think organisations will listen to what you say and believe it, because they know it's from the horse's mouth. And that means we create real value for them and they will come back for more resulting in you and your community getting some much needed cash.

THERE IS NO OTHER COMMUNITY DATA RESEARCH COOPERATIVE WE KNOW OF. YOU'RE PART OF A GROUND BREAKING INITIATIVE.

MADE IN CUMBRIA!

We don't think there is much not to like here but please bear with us in these early days as we will need a bit of time to listen, learn and adapt as we go...so hang onto your hats!

And as our journey unfolds if there are any ways you think you can help then please get in touch - we need all the help we can get!

In the meantime the tiny team here (for the time being) look forward to working on your behalf.

Quentin - Founder Member

As you'd expect the information you provide now and at any point in the future is collected and stored securely by The Community Data Cooperative (a Cooperative society registered with the Financial Conduct Authority Reg No: 4698). We and our partners will hold this information in confidence and comply with our responsibilities under the Data Protection Act 2018 and current GDPR legislation. If you'd like to see our Data Privacy Policy click HERE.

	Yes please	No thanks
Email	Yes please	No thanks
Text	Yes please	No thanks
Telephone	Yes please	No thanks
Post	Yes please	No thanks

	Yes	No	Like to	Never!
Do you currently do any volunteer work in your community?	Yes	No	Like to	Never!
Do you use the Lake District National Park specifically for leisure activities?	Yes	No	Like to	Never!
Are you involved in local politics at all?	Yes	No	Like to	Never!
Do you get involved with local environmental or green initiatives?	Yes	No	Like to	Never!
Have you got specialist skills you think you can share with others in your community?	Yes	No	Like to	Never!

Ok the formal bit. I want to become a Member of The Community Data Cooperative, join this exciting Data For Good Movement and make a difference in my community. I've read and agree to the Rules of the Cooperative (click here)and Terms of Membership (click here) and understand the Co-op will keep all my data and personal details safe in accordance with your privacy policy (click here).		*
	Join me up!

	Complete form using social details
	Now, before we all get too carried away you need tell us a little bit about youself so we can start to build your profile. Profiles are important because down the line the organisations who want to find out what you think about their goods or services also want to know what type of people gave similar responses so they can identify groups, patterns and trends. Here ends the lesson in market research!

Can you tell us your gender? This is just so we can be sure that in the future the most sensible and practical answers are from the women amongst us :-)		*
	Male Female Prefer not to say Other

Please tell us your ethnicity so we can make sure we are attracting Members from all of our communities:		*
	Asian/Asian British Black/African/Caribbean/Black British Mixed/Multi Ethnic Group Other Ethnic Group White Prefer not to say

	The next few questions may seem a bit nosey but the answers help us to create profiles we can attach to the surveys you go onto complete for the Co-op's clients in the future. These profiles mean our clients will get much better insights behind the answers to their questions, which hopefully means they are very happy with us, come back for more and together we create more cash for our communities! First one, what is your job status?
		Full-time employed (30+ hours per week) Part-time employed (less than 30 hours per week) Full-time self employed Part-time self employed On a government training scheme Unemployed – available to work Wholly retired Looking after the home and family Permanently sick/disabled Full- time student (school, university or college) Carer Other :

	Can you tell us your household's approximate income - so that's the combined salary/earnings from everyone that lives there? Again, this information is kept confidential. Please count all income and do not deduct any taxes, national insurance contributions, superannuation or health insurance payments.
		Nil Up to £99 per week or £5199 per year £100 to £199 per week or £5,200 - £10,399 per year £200 to £299 per week or £10,400 - £15,599 per year £300 to £399 per week or £15,600 - £20,799 per year £500 to £599 per week or £26,000 - £31,999 per year £600 to £999 per week or £31,200 - £51,999 per year £1000 or more per week or £52,000 or more per year

	Do you have any kids, aged under 16, living with you at the moment?
		Yes No

	Do you look after any elderly friends or relatives in your spare time, so pop round and make sure they are OK, things like that?
		Yes No

Thanks for answering the above. Now we'd like to ask you for some information on how you feel about where you live. When answering a question about "local" please consider this to be within 15-20 mins walk of your front door. These first couple of questions come from some national surveys the government runs and the answers will enable us to see how our Membership compares to a national average. This is really useful if we want to persuade government or local authorities to increase, for example, funding for community initiatives. The questions we then ask about businesses and charities will help us a get a feel about who is mucking in and helping in the community near you and perhaps more importantly who you think should be. And guess what? We will be knocking on the doors of those you think should be doing more, to see if they can help and/or get involved! So, first question, how strongly do you feel you belong to your local area?		*
	Very strongly Fairly strongly Not very strongly Not at all strongly Don’t know

To what extent would you agree or disgree that people in your local area pull together to improve the local area?		*
	Definitely agree Tend to agree Neither agree nor disagree Tend to disagree Definitely disagree Nothing needs improving Don’t know

	Title:				*

	First Name:				*

	Last Name:				*

	Company:

	Can you tell us the name of any commercial business that you think provides great support or funding for community initiatives near you. The names of up to 3 businesses would be great, if you know that many of course! 1

	Can you tell us the names of any charities/voluntary/council organisations or departments that provide great support or funding for community initiatives near you? Can you separate each organisation with a semi colon please (;).

	And, no great surprise with this question - can you name any organisation you think should be doing more to help out in your community and why?

Last few questions! We'd like to know a bit about how you feel about life in general, what you do to keep healthy and active and what you might like to do? We can then compare your feedback with national statistics from organisations like Sport England and the NHS and then fight for funding in our Members' local areas for more of the things that will make your lives happier and healthier. First big question - how happy are you with your life generally at the moment? Please rate on a scale of 0-10, where 0 is "not at all happy" and 10 "over the moon"!		*
	012345678910

Do you currently do any form of physical activity (e.g walking, walking the dog, gardening, cycling, swimming, team sports, gym/leisure centre etc.)?		*
	Yes, I do as much as I can or want to Yes, I do some exercise but would like to do more No, I don't but I would like to do some No, I don't want to do any exercise

	Last but not least, if you answered yes to the question above asking whether you have skills you'd like to share with your community would you like to tell us about them and maybe we can find someone to take you up on your offer!