Member Details Basic Information First Name Last Name Prefer to be known as Date of Birth Address Street Address Street Address Line 2 Street Address Line 3 City Postal Code County - None - Local Authority (if applicable) - Select -LB Barking & DagenhamLB BarnetLB BexleyLB BrentLB BromleyLB CamdenLB City Of LondonLB CroydonLB EalingLB EnfieldLB GreenwichLB HackneyLB Hammersmith & FulhamLB HaringeyLB HarrowLB HaveringLB HillingdonLB HounslowLB IslingtonLB Kensington & ChelseaLB Kingston Upon ThamesLB LambethLB LewishamLB MertonLB NewhamLB RedbridgeLB Richmond Upon ThamesLB SouthwarkLB SuttonLB Tower HamletsLB Waltham ForestLB WandsworthLB WestminsterOther Local AuthorityUnknown Other Local Authority Contact Details Phone Number Email Preferred Communication Method TelephoneE-MailLetter Privacy Preferences? Do not email me Do not phone me Do not mail me Do not SMS me Do not include me in bulk mailings Membership Material communication preferences ODL sends a monthly listing of groups, activities, and one off events to the membership, with occasional additional updates. Please let us know how you would prefer to receive these. Please subscribe me via Email Post How did you hear about Opening Doors? - Select -Word of mouthSocial mediaOpening Doors websitePress article (paper)Press article (online)LGBT centreFriendsOther (please give details) How did you hear about Opening Doors? (Other) Additional Information Please complete the questions below as fully as possible as it will help ODL to develop better programmes for its members and better represent the needs of older LGBTQ+ individuals. We do not share any of your information with external agencies or services. Gender How would you describe your gender? FemaleMaleTrans FTrans MNonbinaryGender NeutralGender QueerGender FluidAndrogynousOther Please enter your preferred term Is your gender the same as registered at birth? YesNoPrefer not to say Sexual Orientation How would you define your sexual orientation? BisexualGay ManGay Woman/LesbianHeterosexual/ StraightQueerUnknownNot AnsweredPrefer Not To SayOther Please enter your preferred term Ethnicity What is your ethnic group? White - Welsh/English/Scottish/Northern Irish/BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - any other backgroundMixed - White & Black CaribbeanMixed - White & Black AfricanMixed - White & AsianMixed - Any Other Mixed BackgroundAsian or Asian British - IndianAsian Or Asian British - PakistaniAsian Or Asian British - BangladeshiAsian Or Asian British - ChineseAsian Or Asian British - Any Other Asian BackgroundBlack/African/Caribbean/Black British - AfricanBlack Or Black British - CaribbeanBlack/African/Caribbean/Black British - any other backgroundArabOther - Any Other Ethnic GroupUnknownChinese Or Other Ethnic Groups - Chinese Ethnicity (please specify) Disabilities Do you have any long standing physical or mental illness, or disability? YesNo Please elaborate None Dementia Frailty HIV/AIDs Learning difficulties Long term illness Mental health Palliative care Physical Sensory Substance misuse Wheelchair Other Not Answered Disability (please specify) Do any of your illnesses or conditions reduce your ability to carry out day to day activities? Yes, a lot Yes, a little No, not at all Living Arrangements Who do you live with? Lives AloneLives With Family MemberLives With OtherLives With PartnerLives in residential accommodationNot AnsweredUnknown Dependents Is there anyone who is sick, disabled, or older whom you look after or give special help to? YesNoPrefer not to sayNot answered Religion What is your religion/belief/faith? No religionChristian (including Church of England, Catholic, Protestant and all other Christian denominations)BuddhistHinduJewishMuslimSikhPrefer not to sayAny Other ReligionUnknownAtheist Religion (please specify) CAPTCHA Math question 1 + 10 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
