BME Research Panel UK - Registration Form:

Fill out the online form and clink the submit button at the end of the page when you have finished. Please answer ALL items

Please provide the following information:

1) Your Full Name:
2) Your Gender:	Male Female
3) Your Address::
Post Code:
4) Your Age:
5) Your Marital Status:	Married Living together Separated Divorced Single
6) Your ethnic origins: (For example, are you black African descent, or Spanish descent; Portuguese; Indian; Bangladeshi descent, etc...?)
7) Your Annual Income	0 - 10,000 10,001 - 20,000 20,001 - 30,000 30,001 - 40,000 40,001 - 50,000 50,001 - 60,000 More than the above
8) Your highest level of academic achievement:	No qualifications GCSE O Level GCE A Level Diploma BA/BSc MA/MSc MPhil/PhD Post-doctoral
9) Number of dependent children:
10: Your Email Address

Thank you for taking the time to complete this form