connect4D Registration

Name

Age

Contact Number

Email

1. I have the following skills, interests or experience (please tick as appropriate)

Creativity
IT / technical
Research
Public Speaking
Design
Creative Media

2. Have you done any volunteering in the last 12 months? Yes No

3. How often do you socialise with people that are NOT your family members

4. When I socialise I prefer to: Meet People In Person Use Online Social Media / Networks

Tick this box if you are happy for us to use photos and videos of you and with your first name only in reports, case studies and on our website/social media pages to promote our work.

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