Please fill in your details below to become a member of Frimley Health NHS Foundation Trust
Fields marked with * are mandatory.
1. Personal Information
Title
Unspecified
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Capt
Wing Commander
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Lt Col
Hon
Hon Alderman
Sir
Father
Nurse
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Please enter your postcode, and click Get Address
Address *
Town or City
County
Postcode *
Country
Home telephone
Email
Preferred method of contact
Email
Post
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
2. Additional Information
As a member, I would like to
Consider standing for election as Governor
Receive regular information
Attend meetings or events
Participate in the election of the Council of Governors
Become a volunteer
Please select
Public member inside catchment
Patient or carer outside of catchment
Surgery and Surgical Services
Women's and Children's Services
Administration
Diagnostics and Therapeutics Services
A&E, Medicine, Elderly Care, Pharmacy
Postal Returned x2
Staff Heatherwood for Export
3. Review
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Email
Ethnicity
Preferred method of contact
Disabilities
As a member, I would like to
Please select
4. Finish
*
I apply to be a member of Frimley Health NHS Foundation Trust and be bound by the rules of the organisation. 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.
Please tick here if you consent to your details being added to the Public Register.