BBCRadio Gloucestershire and University of Gloucestershire
Election Debate 2017
Application form to become a member of the audience
Many thanks for getting in touch. We’re holding a debate at the University of Gloucestershireon the evening of Wednesday 17th May with Prospective Parliamentary candidates for the Cheltenham constituency invited to take part. BBC Radio Gloucestershire will be recording the debate and we’d love people to join us. We have a limited number of places for audience members, so ask you to please complete this form and return to us by the end of Friday 12th May. The questions below will help us ensure that the audience is as balanced as possible. There are just 2 pages to complete and send back. If you are successful and secure a place, you will be notified by Tuesday 16th May and emailed the e-ticket you will need for free entry. There will be no admittance without an e-ticket.
FULL NAME:
ADDRESS:
POSTCODE:
TELEPHONE NUMBER:
MOBILE PHONE NUMBER:
EMAIL ADDRESS:
OCCUPATION:
AGE: (please circle) 16-24 25-34 35-44 45-54 55-64 65+
Do you have any access requirements? Yes/No
If yes, what assistance do you require? …………………………………………………………………………………..
Do you know any of the candidates standing in the 2017 General Election? Yes/No
If so, in what capacity? ………………………………………………………………………………………………………….
Have you previously had any contact with any of the candidates? Yes/No
If yes, in what capacity? ………………………………………………………………………………………………..
BBC Radio Gloucestershire and University of Gloucestershire Debate p2
If you are a member of a political party, please tell us which one. If not, please just enter “None”:
If there were a General Election tomorrow, for which political party would you be most likely to vote? (please circle)
Conservative
Green
Labour
Liberal Democrats
Independent
UKIP
Would not vote
Undecided
None of the Above
Other (please describe) …………………………………………………………………………………………………….
Do you have a question you would like to be asked? This is optional, you do not have to ask a question to be selected for the audience.However if you do, please write it clearly below:
Many thanks for your time. The information you have provided will be used solely to help us select an audience representing a cross-section of viewpoints. We promise that you will not pass on your details or send you unsolicited mail as a result of supplying your personal details. Once the debate is over, we will securely destroy your personal information. If you are successful and secure a place in the audience we will be in touch shortly. If you don’t hear from us, drop us an email. Please do not just turn up at the debate without confirmation we have a place for you, as we will not be able to let you in. We hope you will be successful and look forward to meeting you there!