Black Women's Health & Wellbeing Research Network Membership

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1.1. Email Address

2.2. First Name

3.3. Last Name

4.4. Role

Please select Academic staff member Professional staff member PG research student PG taught student UG student Non-HE - Public sector Non-HE - Private sector

5.5. Ethnicity

Please select Black Caribbean Black African Black Other Mixed Race Pakistani Bangladeshi Indian Chinese Other Asian White Other Ethnicity

a.5.a. Other Ethnicity

6.6. Gender

Please select Woman Man Non-binary Transgender Intersex Queer/Gender non-conforming Prefer not to say Other

a.6.a. Other Gender

7.7. Country of Residence

8.8. We will use the information you provide on this form only to be in touch with you and for statistical reasons. Please let us know if you would like to hear from us via email.

Yes

No

You can change your mind at any time by sending us an email to jenny.douglas@open.ac.uk. We will treat your information with respect and in accordance to current GDPR regulations. For more information about our privacy practices please visit our Privacy Policy page

9.9. What particular aspects of Black women’s health interests you and why?