New Cross Gate NDC Expo Registration Form

The New Cross Gate Trust

Company Secretary Application Form

1. Please provide your personal details below:

Title (Mr/Mrs/Miss/Ms etc):

First name:

Surname:

Address:

Postcode:

Email:

Phone number:

Nationality:

2. Are you? (please delete as appropriate): Male Female

3. Date of Birth: / /

4. How would you describe your work status at the moment?

 Employed full/part-time /  Self-employed /  Student /  Retired
 Looking after home/family /  Unemployed /  Other

5. Do you consider yourself disabled?

 No / Yes / If yes, what is the nature of your disability? /  Physical /  Sensory
 Mental /  Learning

6. Are you registered as disabled? (delete as appropriate) Yes No

7. Please tick one box to describe your ethnic group:

White / Mixed / Asian or Asian British
 British /  White & Black Caribbean /  Indian
 Irish /  White & Black African /  Pakistani
 Turkish/Turkish Cypriot /  White & Asian /  Bangladeshi
 White Other (Please state) /  Other (Please state) /  Tamil
 Asian Other (Please state)
Black or Black British / Other
 Caribbean /  Chinese
 African /  Vietnamese
 Somali /  Other Ethnic Group
(Please state)
 Black Other (Please state)

8. Please explain why you would like to become the company secretary of the New Cross Gate Trust (continue on a separate sheet if necessary).

9. Please explain the skills, abilities and experience you have that you think would make you suitable for this role.

10. Please explain any knowledge or affiliation you have to the area of New Cross Gate and why you would wish to support the local objectives of the New Cross Gate Trust (continue on a separate sheet if necessary).

11. Please confirm that you are able to attend evening Board and Finance meetings (approximately 10 meetings per year).

 No Yes

Please identify whether you are aware of any potential conflicts of interest in being a trustee for the New Cross Gate Trust.

Signed: ______

Print Full Name:______

Date: ______

Please return your application form to:

Jenny Couper

Strategy and Partnerships Manager

Besson Street Community Gardens

Besson Street

London

SE14 5AE

Or by email:

Should you have any questions in completing the application form you can contact Jenny on 07968278315 / .