MAIDeN Database
User Registration

Please complete the registration form below. MAIDeN will confirm your username and password within two working days. The information you give us will be used in the MAIDeN Dating Agency and may be shared with other registered MAIDeN users searching the MAIDeN Partnership 'Dating Agency'. If you are NOT happy for your information to be shared, please click in this box.

Please complete all fields to enable us to process your application promptly.

	Name:
	Organisation (eg Stroud District Council):
	Service (eg Housing):
	Address:

	e-mail address:
	Phone number:
	Post Code of workplace:
	Username (your choice):
	MAIDeN password (your choice):
	How did you find out about MAIDeN? In which areas of the County do you work? (please click all relevant) Cheltenham Cotswold Forest of Dean Gloucester Stroud Tewkesbury Which issues do you work with? (please click all relevant) access to services children's services community development community safety early years healthy living housing learning disabilities lifelong learning mental health older people Primary Care regeneration schools transport young people Other (please specify):