Join the City Voice

Thank you for your interest in Aberdeen City Voice. By filling in this form you are agreeing to become part of the Aberdeen City Voice panel. We issue up to 3 questionnaires a year to our panellists. Please note you have to be a resident of Aberdeen City and aged 16 years or over in order to join this panel.

* Indicates required information

1. Title*

2. First Name*

3. Surname*

4. Address*

5. Postcode*

6. Email

7. What is your gender?*

MaleFemalePrefer Not to Say

8. What is your year of birth?*

9. In general, would you say your health is? (Please tick one box)

Very GoodGoodFairBadVery Bad

10. Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? (Include problems related to old age)

Yes, limited a lotYes, limited a littleNo

11. What is your employment status?

Employee or self employedUnemployedStudentRetiredPermanent sick/disabledOther, including looking after the home (Please specify below)

Other Please specify:

12. Are there any children aged under 16 in your household?

YesNo

13. Do you own or rent your own home?

Owner occupiedRent from Council or housing associationRented privatelyRented with job/business (tied)Other (Please specify below)

Other Please specify:

14. What is your ethnic group?

ScottishOther BritishOther WhiteAfrican or CaribbeanArabAsianOther ethnic group (please specify)

Other Please specify:

15. How did you find out about joining the panel? (Please check one box)

By receiving an invitation through the postBy seeing an advert on the internetBy seeing an advert in the paperLeaflet from a libraryLeaflet from a council officeLeaflet from The Point/Marischal College Customer Service CentreLeaflet from a community centre/sports centreLeaflet from a schoolLeaflet from a doctor's surgeryOther (Please specify)

Other Please specify:

16. We try to save paper (and postage costs) where we can, and offer all City Voice members the option to receive surveys by email. Please indicate below how you would prefer to receive City Voice surveys. (Please tick one box)*

Paper/MailElectronic/Online

If you ticked Electronic/Online for the above question, please make sure you have supplied your email address in Question 6.

17. The City Voice is a partnership between Aberdeen City Council, Aberdeen Council of Voluntary Organisations (ACVO), Fire Scotland, Police Scotland, NHS Grampian, and the universities and college. All members receive up to 3 City Voice surveys a year. We would also like to occasionally invite members to take part in other consultations run by the Council or other City Voice partners.

Your participation is always optional, if you would like to hear about these consultations please tick one or more of the boxes below.

I would like to hear about other council consultationsI would like to hear about consultations being run by other City Voice partners

Any personal information provided by you will be kept strictly confidential. It will be accessible only to Aberdeen City Council and other City Voice partners, and used only to run City Voice surveys and to invite members to take part in other consultations run by City Voice partners (unless you opt out of this). Your information will be held in accordance with the Data Protection Act 1998.