Please fill in your details below to become a member of The Royal Orthopaedic Hospital NHS Foundation Trust
Fields marked with * are mandatory.
1. Personal Information
Member type
Public
Staff
Title
Unspecified
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Capt
Wing Commander
Col
Major
Commodore
Cllr
Sister
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Not Stated
Male
Female
Please enter your postcode, and click Get Address
Address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
Email
Preferred method of contact
Email
Post
Telephone
SMS
2. Additional Information
Special Postal Requirements
Large Print
Audio Tapes
Braille
Disabilities
No
Yes
A physical disability
A mental health problem
A learning disability
Any other special need
Registered disabled
How would you like to be involved?
Consider standing for election as a governor
Find out more about the work of the Trust
Advocate for the Trust within the community
Special events and activities
Interested in becoming a volunteer
Become a fundraiser
I would like to be sent surveys to my home
I would like to be involved in the hospital charity
Other
How did you hear about the trust?
Patient mailing
Face-to-face recruitment
Radio advertisement
Via website
Facebook/Twitter/Youtube
Patient Survey
3. Review
Member type
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Mobile
Email
Special Postal Requirements
Preferred method of contact
Disabilities
How would you like to be involved?
How did you hear about the trust?
4. Finish
*
I apply to be a member of The Royal Orthopaedic Hospital 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.