Member type	Public Staff
Title	Unspecified Mr Mrs Miss Ms Dr Professor Canon Reverend Wing Commander Capt Col Major Commodore Cllr Sister Master Lady Mayor Pastor Nurse Father
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Preferred method of contact	Email Post Telephone SMS
Ethnic Origin	Not stated White - English, Welsh, Scottish, Northern Irish, British White - Irish White - Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Mixed Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Asian or Asian British - Other Asian Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Black Other Ethnic Group - Arab Other Ethnic Group - Any Other Ethnic Group
Sexual Orientation	Not Stated Gay Heterosexual Lesbian Not Stated Prefer not to say
Marriage/CP status	Unspecified Divorced In a civil partnership Married Not Stated Single Widow/Widower

Special Postal Req	Large Print Audio tapes Braille Other (please list in ‘Notes’ section) Voting Preference - Electronic Voting Preference - Postal
Disabilities	No Yes A sensory disability A physical disability A learning disability A mental health problem Any other special need (please list in the 'Notes' section)
How would you like to be involved?	Consider standing for election as governor Completed questionnaire Attend meetings Attend events Consider standing for election Receive regular information
Service preferences?	Medicine Women's health Children's services Surgery National Spinal Injuries Centre Outpatient services Other support services (please list in ‘Notes’ section)
How are you connected with the Trust?	A past patient
How did you hear about the trust?	Online Application Public meetings Public consultation mailing Other (please list in 'Notes')

Member type
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
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Postcode
Country	UK
Home telephone
Mobile
Email
Twitter
Ethnic Origin
Sexual Orientation
Marriage/CP status
Special Postal Req
Preferred method of contact
Disabilities
How would you like to be involved?
Service preferences?
How are you connected with the Trust?
How did you hear about the trust?

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