If you would like information or support from the TFT staff team, please send us a message using this form. For those seeking personal support or membership, please note that this form may take 15 minutes or more to complete. It is important that we receive detailed information about you and what help you are looking for, both so that we can decide on the best way to help you and also so that we can protect the privacy of our existing members and voluntary workers. Where there is a * you must complete this part of the form. When you submit the form, a copy of the information you provided will be emailed to the email address you provide. If you wish to invite a speaker from TFT to come to your church/event, there is a dedicated form to complete. Note that all information supplied will be treated in accordance with our Code of Confidentiality. Alternatively, you can write to us at True Freedom Trust, 75 Albion Street, Birkenhead, CH41 5LS, UK or phone us on +44 (0)151 653 0773. About your message Reason(s) for contact * Advice or support (for yourself or others) Interest in a conference/event Interest in joining a local or online support group Application for membership of TFT (or change how you receive the newsletter) Request for resources (leaflet, book, recording etc) Referral to a counsellor Request an accountability partner Writing/academic/media project Other Tick all that apply. Please choose carefully, as your selection here determines what we will ask you for later in this form. If you would like someone from TFT to speak at your church/organisation, please fill out this form instead. Whom does your enquiry mainly concern? * MyselfMy son/daughterAnother relativeA friendA member of my churchEnquiry does not concern an individual Main issue(s) Same-sex attraction Gender identity Other Please tick which issue(s) you are contacting us about Are you a new contact? * - Select -This is the first time I've contacted TfTI have contacted TfT beforeI am a member of TfT Please indicate whether this is the first time you have contacted TfT Referred by Enter "Self" if you referred yourself Declaration * I consent to TfT storing my personal data in line with the Data Protection Act 1998. I would like a TfT staff member or voluntary worker to contact me, using the details given in this form. I understand that a copy of this form will be passed to the person who will be contacting me. Basic contact detailsPlease enter your essential contact details Title - None -MrMrsMissMsDrDr & MrsMr & MrsRevd & MrsRevdRevd DrThe Most RevdThe Right RevdCanonFriarPastorSisterCaptainProfessorRevd & Revd First Name * Last Name * Gender * - Select -FemaleMaleCoupleCouple (man is main contact)Couple (woman is main contact)Transgender (M>F)Transgender (F>M) Country * AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Rep of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Rep ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaS Georgia & S Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUS Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe County or state * Aberdeen, Bristol, Dundee, Edinburgh and Glasgow are listed as cities. Manchester is included in "Greater Manchester". Telling us the region where you live helps us to identify what local support would be available. Email * Email category PersonalWorkChurchOther Detailed contact informationBecause you have selected application for membership or requesting a counsellor, we require some more detailed contact information in addition to the basic information provided above. Street address * Street address (cont) Town or city * Postcode Preferred phone number Type of phone * LandlineMobileFaxPagerVoicemail Phone location * PersonalWorkChurchOther Preferred communication method(s) Phone Email Post Text message Tick the method(s) by which would prefer us to contact you Privacy preferences Do not email Do not phone Do not send post Do not text message Tick any method(s) by which you would NOT want to be contacted Date of birth Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007 Membership questions Agree to Basis? * Yes No Our Basis declares (amongst other things) that “any sexual relationship outside of a marriage between a man and a woman falls short of God's plan for His creation”. Are you in agreement with our Basis? Agree to Code of Confidentiality? * Yes No Do you agree to be bound by our Code of Confidentiality? Newsletter preference * Newsletter by email Newsletter by post Prayer newsletter If you are accepted for membership, please tick here how you would prefer to receive your quarterly newsletters. Please also select "Prayer newsletter" if you would like to receive our prayer newsletter by email. Existing supportYou may wish to tell us about the the local support you currently receive Church denomination - None -AnglicanAssemblies of GodBaptistBrethrenCatholicIndependent EvangelicalMethodistNew FrontiersPentecostal (inc Elim)PresbyterianSalvation ArmyURCVineyardMuslimOther Pick a denomination that most closely matches your own church (if you attend church) Church name Vulnerability assessment Ongoing contact with mental health services Addiction to drugs or alcohol Physical disability It helps any staff or volunteer who meets with you to be aware of any issue that may impact on attending events/groups etc. Please tick any relevant boxes below and provide further details with your main message. MessageThe large text box below is for your main message to the TFT staff team. For those seeking personal support or membership, please note that it is important that we receive detailed information about you and what help you are looking for, which will be treated in confidence. This is so that we can decide on the best way to help you and also so that we can protect the privacy and confidentiality of our existing members and voluntary workers. Subject Message detail Confirmation of agreementsListed below for your information are the agreements you made earlier in the form. Date of consent to holding of personal data: Day Day12345678910111213141516171819202122232425262728293031 Month MonthMayJunJulAug Year Year2017 You have consented to TfT storing your personal data in line with the Data Protection Act 1998. Date of agreement to Basis: Day Day12345678910111213141516171819202122232425262728293031 Month MonthMayJunJulAug Year Year2017 You have agreed to our Basis. Date of agreement to Code of Confidentiality: Day Day12345678910111213141516171819202122232425262728293031 Month MonthMayJunJulAug Year Year2017 You have agreed to be bound by our Code of Confidentiality. 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