1 Start 2 Complete Name * Membership number * Phone (your main phone number, either mobile or landline) * Email (if you have one) Tell us about the positive impact Haringey Circle has had on your life * If you could provide one short quote, what would it be? * Would you be happy for us to share your story on our website? * Yes No Would you be happy for us to share your quote on our website? * Yes No If you do provide permission for us to use your story or a quote, can we use your first name, or would you prefer to remain anonymous? * Use my first name I'd prefer to remain anonymous (your name will not be used) If you do provide permission for us to use your story or a quote, could we use a photo of you? * Yes No If we needed to get in touch, how would your prefer us to contact you? * Phone Email Please don't contact me Submit
