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<input type="hidden" id="PAGE" name="PAGE" value="1"><table summary="margins" width="100%"><tr><td colspan='3' style='height:3.0em;'></td></tr><tr><td style='width:3.0em;'>&nbsp;</td><td><table class="V2_classT" style="width:100%;" summary="Question" id="V2"><tr><td class="question_1" style="width:100%;"><h2 class="question_2"><img src="http://www.snapsurveys.com/swh/k/126512510565/survey_top_small.jpg" alt="survey_top_small" width='941' height='188' ></h2></td></tr></table><table style="width:100%;" summary="Spacer" id="V4_SPACER"><tr><td style="height:18px;"></td></tr></table><table class="V4_classT" style="width:100%;" summary="Question" id="V4"><tr><td class="question_3" style="width:100%;"><h2 class="question_4">Islington Citizens Panel<br>New Member Details</h2></td></tr></table><table style="width:100%;" summary="Spacer" id="V5_SPACER"><tr><td style="height:18px;"></td></tr></table><table class="V5_classT" style="width:100%;" summary="Question" id="V5"><tr><td class="question_3" style="width:100%;"><h3 class="question_5">If you would like to be part of Islington Citizens Panel, please complete this<br>recruitment questionnaire.</h3></td></tr></table><table style="width:100%;" summary="Spacer" id="V6_SPACER"><tr><td style="height:18px;"></td></tr></table><table class="V6_classT" style="width:100%;" summary="Question" id="V6"><tr><td class="question_3" style="width:100%;"><h3 class="question_5">One of our priorities is to consult and engage with all communities living in<br>Islington. The information we are asking for will enable us to make sure the<br>panel is properly representative of the local population. However, if you feel<br>uncomfortable answering any particular question you can leave<br>it blank.</h3></td></tr></table><table style="width:100%;" summary="Spacer" id="V7_SPACER"><tr><td style="height:18px;"></td></tr></table><table class="V7_classT" style="width:100%;" summary="Question" id="V7"><tr><td class="question_3" style="width:100%;"><h3 class="question_5">Please be assured that the information is held under the terms of the Data<br>Protection Act and that our research agency, Quality Fieldwork, is also<br>bound by the Code of Conduct of the Market Research Society in matters<br>of confidentiality.</h3></td></tr></table><table style="width:100%;" summary="Spacer" id="V8_SPACER"><tr><td style="height:18px;"></td></tr></table><table class="V8_classT" style="width:100%;" summary="Question" id="V8"><tr><td class="question_3" style="width:100%;"><h3 class="question_5">Alistair Smith<br><span class="textspan_1">Corporate Consultation and Research Manager<br>Islington Council</span></h3></td></tr></table></td><td style='width:3.0em;'>&nbsp;</td></tr><tr><td colspan='3' style='height:3.0em;'></td></tr></table><div align="center"><img class='tools_1' src="http://www.snapsurveys.com/swh/k/126512510565/is1278_line.gif" alt="dividing line"></div><table summary="buttons" width="100%"><tr><td  style='text-align:center;'>&nbsp; <img class='tools_1' src="http://www.snapsurveys.com/swh/k/126512510565/is1278_pbar01.gif" alt="Page 1/10"> &nbsp;</td></tr><tr><td  style='text-align:center;'>&nbsp; <input type="image" class='tools_2'src="http://www.snapsurveys.com/swh/k/126512510565/is1278_rset.gif" alt="Clear Answers from this Page" name='reset' value="Reset"> <input type="image" class='tools_2'src="http://www.snapsurveys.com/swh/k/126512510565/is1278_next.gif" alt="Next Page" name='next' value="Next &gt;&gt;"> &nbsp;</td></tr></table></form>
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