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

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

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:

*  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.