What kind of future would you like to see for the Meres and Mosses?

Be part of the conversation,explore challenges and opportunities for the area, local people and businesses – your views will be considered to shape decision-making, locally and perhaps beyond…..

We would like 2 hours of your time

We want people from all walks of life to join in, we want to hear from people living, working and playing in the Meres and Mosses area of North Shropshire and South Cheshire

If you are interested in helping us, please answer the questions below and return this form to us

We ask these questions in order to ensure we get a representative and diverse mix of participants

If you are selected we will get in touch to let you know you have a place, workshops last 2 hours and are held in the evenings, when you attend the workshop we will reimburse you with £35to cover travel and as a thank-you for taking part.

If your postcode does not appear then we are sorry but we do not need to speak with you:

SY12; SY13; CW1; CW2; CW5; CW98

The workshop will be held at Bickley Hall Farm, Bickley Lane, Malpas, SY14 8EF

6.45pm – 9pm on 15/07/14

Have you heard about the Meres and Mosses Landscape Partnership and / or the Nature Improvement Area (NIA) before? LPS NIA Neither

Male Female

Age:

25-34 / 35-44 / 45-54 / 55-64 / 65-74 / 75+

Employment level of main income earner in household:

Higher managerial, administrative or professional e.g. Doctor, Lawyer, senior manager / Intermediate managerial, administrative or professional e.g. bank manager, teacher
Junior managerial, supervisory or clerical e.g. shop floor supervisor, bank clerk, sales person / Skilled manual work e.g. Mechanic, electrician, carpenter, builder
Semi or Unskilled manual work e.g. assembly line worker, refuse collector, messenger, shop worker / Casual work, pensioner, unemployed, on benefits

Do you have any long standing illness, health problem or disability that limits your daily activities or the kind of work you can do? Yes No

Are you:

White British / White Irish / White Other / White & Black Caribbean
White & Black African / White & Asian / Other Mixed / Indian
Pakistani / Bangladeshi / Other Asian / Caribbean
African / Other Black / Chinese / Any Other

Which, if any, of the following types of TV programmes have you watched in the past month?

Cooking / Science and Technology / Nature and Wildlife
Farming and Rural affairs / Soap Opera or Sitcom / Reality TV show
Sport / None – I have not watched any TV in the past month / Other – Please specify
Name:

Address:

House number / Name
Street
Town
County
Postcode
Email:

Telephone: only give us telephone numbers if you do not mind being called on this number

Home
Mobile
Work

If you wish for your details to be added to our mailing list for future events please tick

Please return this form by email to:

By Post:Luke Neal, Community Officer, Meres and Mosses Landscape Partnership Scheme

c/o Shropshire Wildlife Trust, 193 Abbey Foregate, Shrewsbury, SY2 6AH

If we have not ben in touch by July 7th 2014 then we regret that you have not been selected

We apologise that we cannot reply to all respondents

Your information will be used solely by the Meres and Mosses Landscape Partnership Scheme for the purposes of this study and shall not be passed on to any third parties