Please fill in your details below to become a member of Leeds and York Partnership NHS Foundation Trust
Fields marked with * are mandatory.
1. Personal Information
Member type
Public
Service User or Carer
Title
Organisation
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Capt
Wing Commander
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Bishop
Esq
Inspector
Lord
Rt. Hon
Sire
Police Constable
Sheriff
Sheriff's Lady
First name *
Last name *
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Transgender
Please enter your postcode, and click Get Address
Address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
Email *
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
Sexual Orientation
Gay/Lesbian
Heterosexual
Bisexual
Asexual
Not Stated
2. Additional Information
Level of involvement – as a member you will automatically receive news about the Trust, information about governor elections and an invite to our Annual Members’ Meeting.
In addition to the above, please tick how you would like to be involved:
I am interested in becoming a governor
I'd like to receive info about projects that involve service users and carers to improve services
3. Review
Member type
Last Used Services
Title
First name
Last name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Mobile
Email
Ethnicity
Sexual Orientation
Do you consider yourself to have a disability?
In addition to the above, please tick how you would like to be involved:
4. Finish
*
I apply to be a member of Leeds and York Partnership NHS Foundation Trust. I confirm that I am over 16 years of age, I live at the above address and I do not work for Leeds and York Partnership NHS Foundation Trust.
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.