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Applicant details

Type of User:
First Name: *
Last Name: *
Other:
Contact Number: *
Address Number: *
Building Name:
Address Line 1: *
Address Line 2: *
Town / City: *
Region: *
Post Code: *
Country: *
LCR region:
Which gender do you identify with ?: *
Do you experience a health condition?: *
Other health condition:
Do you experience a disability?: *
Notes for other disability:
Please self-define your ethnicity if comfortable.:
Please self-define your ethnicity if comfortable.::
Please select ALL socially-trading traits that apply to you or your company:
Please select ALL socially-trading traits that apply to you or your company: *
Would you like to become a BlaST member?: *
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The BlaST Network (Black/Brown-led social Traders) is designed to recognise the impact and contribution of socially-trading organisations (STOs) led by those with Black-lived experience and expertise. The network promotes the work and communicates the positive social or environmental impact that BlaST-led businesses have on their local communities.
If you are an STO, would you like to become part of our Social Directory: *
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About your Organisation

Upload your logo:
Drop files here or
Allowed file types: jpg,jpeg,gif,png,bmp,ico
The Dimension of the image should be 1080 X 400 and File size should be maximum 2mb .Image will be auto re-sized to these dimensions
Drop Here Preview Drag & Drop or Select Files Add More Maximum limit for a file is __DT__ Maximum limit for total file size is __DT__ Minimum __DT__ file is required Maximum limit for total file is __DT__ Maximum allowed size per file is __DT__ Maximum total allowed file size is __DT__ Minimum __DT__ file is required Maximum __DT__ files are allowed
What is organisation's legal status:
Other organisation's legal status:
What is the name of your organisation: *
What is your job title in this organisation:
Do 50% or more of your leader(s), founder(s), or leadership team identify as:
Black or other Minoritised Ethnicity (old- field): *
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Black or other Minoritised Ethnicity: *
Female (old- field): *
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Female: *
Having a disability (including physical, mental, cognitive differences, or a long-term health condition) (old- field): *
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Having a disability (including physical, mental, cognitive differences, or a long-term health condition): *
From an educationally or economically disadvantaged background (e.g., eligible for free school meals or did not complete formal education) (old- field): *
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From an educationally or economically disadvantaged background (e.g., eligible for free school meals or did not complete formal education): *
Please tick all categories that you identify with (old-field): *
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Please select all categories that you identify with: *
Explain what yours organisation does:
What is the principal trading category of your organisation: *
Please provide a maximum three other categories. This is to help potential businesses looking to trade with you and understand the services you provide:
Other Principal trading category suggested by user:
Other Sub category suggested by user:
Please select all the Socially-trading traits that you identify with: *
Please select all the Socially-trading traits that you identify with:
Please select all the Socially-trading traits that you identify with:
Is your address open to the public?: *
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Disabled access:
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Add your promotional Video. Enter a Youtube / Vimeo Video URL link:
How are you constituted? (CIC, LTD etc.):

Organisation's contact details

Address Number: *
Building Name:
Address 1: *
Address 2: *
Town: *
City: *
Region: *
Country: *
Postcode: *
Liverpool City Region (LCR): *
Telephone number: *
Email address: *
Website: *
*
*

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