Citizens' Panel Registration Form

Thank you for agreeing to be part of our new panel. Would you please complete the details about yourself below.

Your contact details
About you


  • Which group do you consider yourself to belong to? (please tick one)
  • White




    British
    Irish
    Any other White background
  • Mixed





    White and Black Caribbean
    White and Black African
    White and Asian
    Any other Mixed background
  • Asian or Asian British





    Indian
    Bangladeshi
    Pakistani
    Any other Asian background
  • Black or Black British




    Caribbean
    African
    Any other Black background
  • Chinese or other ethnic group



    Chinese
    Other (please state below)


Declaration
By submitting this form you give consent for this data to be held on Mansfield District Council's Citizens' Panel database.



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