North East Derbyshire District Council                         CITIZENS' PANEL


This questionnaire asks you for information about you and your household, we need these details to make sure that the North East Derbyshire Citizens' Panel represents all the people in North East Derbyshire. If you would like to take part in the Citizens' Panel please fill in the questionnaire. Although we ask you to sign up to take part in the Panel, you are free to withdraw at any time.



All of the information that you give will be held securely and will be treated as confidential. The information that you provide will be used only for the purpose of administering the Citizens' Panel. Any information you give in future North East Derbyshire Citizens' Panel questionnaires will be anonymous and will be processed only by North East Derbyshire District Council.

Your data will be maintained in accordance with the Data Protection Act 1998 and will not be passed on or sold to any other organisation.

Q1How would you like to be involved in the Citizens' Panel?  (Please select as many boxes as apply)
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