Islam in Wales Project Sign Up Form

Page 1: Page 1

Islam UK Centre Banner

Islam in Wales/Islam Yng Nghymru

Project Sign Up Form / Ffurflen Gofrestru i Prosiect

You don't have to answer every question / Does dim rhaid i chi ateb bob cwestin

1.1. Name/Enw:

2.2. Email Address/Cyfeiriad Ebost

3.3. Mobile Phone Number/Rhif Ffôn Symudol

4.4. City/Dinas:

5.5. Date of Birth/Dyddiad Geni:

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

6.6. Gender/Rhyw:

7.7. How would you describe your ethnicity? Sut Byddech Chi'n Disgrifio'ch Ethnigrwydd

8.8. Which of the below are you interested in (select all that apply): Pa un o'r isod y mae gennych ddiddordeb ynddo (dewiswch bob un sy'n berthnasol):

I would like to be kept informed about the project

I would like to undertake oral history interviews with friends/family for the project

I would like to submit an item/items for archiving

I would like to submit a "My Family History" document for my family

I would like to be interviewed for the project

9.9. Add any comments, suggestions, or feedback you wish below: Unrhyw Beth Arall: