The Work Room – Membership Form

Please note: All the information you give us on the form will be used for our own administrative purposes only.​ ​ We will only share your contact details ​with a third party if we receive your permission in advance. The equalities information you share with us will be kept confidential and your answers will be analysed and reported on anonymously and without any reference to your membership details.

The Work Room is committed to equality and to taking action to avoid discrimination within the organisation. It will assist us if you can provide information below in order that we can assess, monitor and review the profile of our membership.



Ethic Origin


Asian or Asian British

Black or Black British


Other Ethnic Group

Religious belief/Faith

Sexual orientation

Do you consider yourself to have a disability?

Please note: If you have answered yes to this question, and you require any adjustments to be made in order for you to participate fully in our programme, please indicate the adjustments we might make below so we can accommodate your needs.

We'd really appreciate it if you could fill out the following questions, your information will directly inform our equality and diversity policies moving forward.

How well do you consider The Work Room to cater for your equalities, diversity and inclusion needs at present?
1 – not at all well, 2 – adequately, 3 – don’t know, 4 - well, 5 – very well

Please comment on any positive experiences you have had of ways in which The Work Room has accommodated your equalities, diversity and inclusion needs to date, if appropriate:

Please tell us how we might improve our approach to equalities, diversity and inclusion to accommodate your needs:

Please enter last 4 digits of our main telephone number (shown at the bottom of this page):