Fields marked with * are mandatory.Other fields are voluntary but by giving us statistical information about yourself you are helping us to measure and work towards building a Foundation Trust membership that is representative *Individuals who are providing services to the Trust who are not automatically staff members may apply for membership of the staff constituency by emailing Foundation.trust@addenbrookes.nhs.uk
1. Personal Information
Member type
Please select your category from the options listed
Public
Patient
Title
Unspecified
Mr
Mrs
Miss
Ms
Mx
Dr
Professor
Canon
Wing Commander
Reverend
Capt
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Dame
Lord
The Reverend Dr
The Right Honourable
Sir
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Non-binary
Other
Please enter your postcode and click Get Address
Home address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
The trust is committed to saving money on printing, paper and postage and therefore only communicates regularly with members via email.
Email
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
Religion/Belief
Not Stated
Atheism
Buddhism
Christianity
Hinduism
I do not wish to disclose my religion/belief
Islam
Jainism
Judaism
Other
Sikhism
Undefined
Sexual Orientation
Not Stated
Heterosexual or Straight
Gay or Lesbian
Bisexual
Other sexual orientation not listed
Not Sure
Prefer not to say
2. Additional Information
Special Postal Req
Large Print
Voting Preference
Electronic Voting (go green and also save the Trust vital funds)
Paper Voting
Disabilities
No
Yes
A sensory disability
A physical disability (mobility)
A learning disability
Mental Health
Any other special need (please list in the 'Notes' section)
Hearing Impaired
Sight Impaired
How would you like to be involved?
Find out more about the work of the Trust
General Trust news
Information regarding research
Interested in attending Medicine for Members
Interested in attending public Council of Governors meetings
Interested in attending the Annual Members Meeting
Fundraising
Take part in consultation of the Trust's plans
Volunteer at the Trust
Interested in being a Governor
Service preferences?
Adult Mental Health Service
Allergy Service
Audiology Service
Bariatric Surgery Service
Behind the scenes of the hospital
Blood and Marrow Transplantation Service
Breast Surgery Service
Cardiac Surgery Service
Cardiothoracic Surgery Service
Cardiothoracic Transplantation Service
Clinical Genetics Service
Clinical Haematology Service
Clinical Oncology Service
Colorectal Surgery Service
Community Sexual and Reproductive Health Service
Dental Medicine Service
Dermatology Service
Diabetes Service
Dietetics Service
Ear Nose and Throat Service
Eating Disorders Service
Elderly Medicine Service
Emergency Medicine Service
Endocrinology Service
Gastroenterology Service
General Surgery Service
Gynaecology Service
Haemophilia Service
Hepatobiliary and Pancreatic Surgery Service
Infectious Diseases Service
Intensive Care Medicine Service
Interventional Radiology Service
Issues affecting our workforce
Learning Disability Service
Midwifery Service
Neonatal Critical Care Service
Neurology Service
Obstetrics Service
Occupational Therapy Service
Ophthalmology Service
Outpatient services
Paediatric Service
Pain Management Service
Palliative Medicine Service
Physiotherapy Service
Plastic Surgery Service
Podiatry Service
Post-COVID-19 Syndrome Service
Prosthetics Service
Rare Disease Service
Renal Medicine Service
Rheumatology Service
Speech and Language Therapy Service
Spinal Injuries Service
Spinal Surgery Service
Stroke Medicine Service
Thoracic Surgery Service
Transplant Surgery Service
Trauma and Orthopaedic Service
Trauma Surgery Service
Tropical Medicine Service
Upper Gastrointestinal Surgery Service
Urology Service
Vascular Surgery Service
Well Baby Service
How are you connected with the Trust?
A patient past or present
A carer of someone who is a patient
Have worked for Trust in the past
Live in the local area
How did you hear about the Trust?
Online Application
Other (please list in 'Notes')
Patient Mailing
Face to face recruitment
Through an employee of the Trust
Patient information screens
Leaflets
Newsletter
Media
Trust website (www.cuh.org.uk)
3. Review
Member type
Please select your category from the options listed
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Mobile
Email
Ethnic Origin
Religion/Belief
Sexual Orientation
Voting Preference
Special Postal Req
Disabilities
How would you like to be involved?
Service preferences?
How are you connected with the Trust?
How did you hear about the Trust?
4. Finish
*
I apply to be a member of Cambridge University Hospitals NHS Foundation Trust and be bound by the rules of the Trust’s constitution. I give consent to the processing of my information.
The data you supply will be used only to contact you about the Trust, membership or other related issues and will be stored in accordance with the current Data Protection Act. Please click
here
for full details.
Foundation Trusts are required to publish a list of their public members. The only information published is your name and the constituency where you live. If you do want to appear on this list, please tick the box.