Self Build and Custom Build Registration Form

Submission Details

Title

First Name

Last Name

Email Address

Telephone Number

Postal Address

Postcode

Your Nationality

Are you over 18 years of age?

Yes

Connection to East Staffordshire

What is your connection to East Staffordshire? (Select all that apply)

I live in East Staffordshire

I work in East Staffordshire

I have a family connection in East Staffordshire

Member of the Armed Forces

None of the above