This form is to be completed by a new member. You are eligible to become a member in one category only - patient or public.
If you are already a patient or public member, and have re-applied to become a member, we will cross check your details and contact you.
Fields marked with * are mandatory. By completing the voluntary fields about yourself, you will help us measure and build a representative Foundation Trust Membership.
Employees who are on permanent or fixed term contract of at least 12 months and Trust volunteers, automatically become staff members. Other Individuals who are providing services to the Trust, may apply as staff members by emailing the Foundation Trust Membership Office - [email protected].