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 Duke
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Ethnicity	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

Special Postal Requirements	Large Print Braille Audio Tapes
Disabilities	No Yes Deafness or severe hearing impairment Blindness or severe visual impairment A condition that substantially limits one or more basic physical activities A learning difficulty (e.g. dyslexia) A learning disability (e.g. Downs Syndrome) A long-standing psychological or emotional condition Other, including any long-standing illness
How would you like to be involved?	Consider standing as a Governor Be consulted on changes to the Trust's Constitution Comment on service developments and improvements Help develop better information for service users and carers Meet and engage with Governors at Constituency meetings Be involved in planning/developing and monitoring the Trust's services Help to recruit more members Receive regular information Take part in staff development/induction Take part in workshops & focus groups Receiving documents through post and giving your opinion on content, e.g. layout, design, language Attending events and meetings where the views of public are needed Undertaking observations or audits of staff and patient activity Being a mystery shopper/patient Interviewing patients by telephone with a pre-determined questionnaire Acting as a buddy for new Health Panel members Giving presentations on Health Panel work that you have been involved in
Are you interested in any of the following groups?	Asylum seekers and refugees Carers and advocates Children & young people People with dementia Faith groups Gender groups (lesbian, gay, transgender) Black & minority ethnic groups Single parents All disabilities Hearing impared Learning disability Mobility impared Visually impared

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Title
First name
Last name
Middle name
Date of birth
Gender
Address
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Country	UK
Home telephone
Mobile
Email
Ethnicity
Special Postal Requirements
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How would you like to be involved?
Are you interested in any of the following groups?

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