Form for street outreach/door knocking Basic infoFirst name*Second name*Email*Don't have an email address? Use their phone number as the start of a fake email e.g. 07500877172@noemail.com. Please make sure to enter a unique value *not just something generic like noemail@gmail.com*. Phone number*Postcode*Borough*BrentHackneyHaringeyLewishamNewhamTower HamletsBarking and DagenhamBarnetBexleyBromleyCamdenCity of LondonCroydonEalingEnfieldGreenwichHammersmith and FulhamHarrowHaveringHillingdonHounslowIslingtonKensington and ChelseaKingston upon ThamesLambethMertonRedbridgeRichmond upon ThamesSouthwarkSuttonWaltham ForestWandsworthWestminsterOutside of LondonName of union member or staff who is signing up this new member/contact*What kind of sign up is this?* Paying member Just collect contact details Further infoStreet addressWe need this to send you a membership pack! What kind of housing do you live in?Renting from a private landlordCouncil homeHousing association homeI own my own homeTemporary accomodationOtherDo you know the name of your landlord?We support each other with our housing issues. Do you have any problems with your housing you'd like to talk to other members about?Give details in the box below. If this person is signing up as a member, someone will try to give them a call to share basic renters rights info and invite them to a meeting. Facing eviction Rent debt Deposit issues Disrepair Overcrowding Rent rise/rent unmanageable Homelessness/access to housing Harrassment Other (please write more details in the next box) Notes for person filling out this formIs this person a priority to follow up with? Why?If you think we should follow up with this person about the housing issues they're facing, please give details about the issue they're facing What are the main issues this person cares about?What would they like to change about the housing system? Where are you doing this sign up?StallDoor knockingLRU meeting/eventNon-LRU eventAdd this person to a local group or branch?If this person lives outside your borough/branch area but you want them to get updates and calls from your branch, select an option below.NoBrentHackneyHaringeyLewishamNewham & LeytonstoneTower HamletsDoes this person sign the Lewisham disrepair petition? Yes NameThis field is for validation purposes and should be left unchanged.