Data Consent Form logo


Please fill in the form below. When you click 'Send' it will be sent as an email to John Summerwill.
Alternatively, you may print a hard copy and post it to the Circuit Office. Click here for a printed form

* ESSENTIAL

Title and Name (e.g. Mrs Name Surname):
* ESSENTIAL



(unless you wish to exclude contact by mail)


(unless you wish to exclude contact by phone)


(used to distribute directories etc)

Click on all the boxes below to which you consent; leave blank the ones you do not consent to.

I CONSENT TO THE LEEDS NORTH & EAST CIRCUIT CONTACTING ME BY:

Postal address
email
phone

I CONSENT TO MY CONTACT DETAILS BEING SHOWN OR GIVEN AS FOLLOWS


Circuit
Plan
Circuit
Website
Circuit
Directory
District & Connexion
Postal address




email address




phone numbers




Type here any other message