Member type	Public
Title	Unspecified Mr Mrs Miss Ms Dr Professor Canon Reverend Capt Wing Commander Col Major Commodore Cllr Sir Sister Master Lady Mayor Lord
First name *
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Date of birth *	DD MM YYYY
Gender	Unspecified Male Female Transgender
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	Postcode House name/number
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Preferred method of contact	Email Post Telephone SMS
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
Faith	Not Stated Atheism Buddhism Christianity Hinduism Islam Jainism Judaism Sikhism I do not wish to disclose Agnostic Other (please state in the notes box on selection)
Sexual Orientation	Not Stated Heterosexual Gay Lesbian Bisexual I do not wish to disclose

Do you consider yourself to have a disability?	No Yes
How would you like to be involved?	Keep in Touch - you'll receive a regular newsletter Get Involved - attend events and help with surveys Work with the NHS Foundation Trust - we'll keep you informed about becoming a Governor
Service preferences	All / Everything Anything else? Add to the notes box below Cancer services Long Term Conditions Older people's services Outpatients Urgent Care (Emergencies) Women and Children's Services
How are you connected with the Trust?	A current patient A past patient I am a Carer
How did you hear about the trust?	Caring for You event Constituency Meeting Elections Employer (Please state) Forever Friends Fundraising Friends of the RUH From a member of staff at RUH GP or Surgery event Hospital correspondence Hospital Magazine - Insight Letter through the door Maternity Membership Leaflet Newspaper Outpatient Appointment Letter PALS/Complaints/Compliments RUH Website Staff Leaver Thank You Letter Welcome Letter Word of mouth

Member type
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country	UK
Home telephone
Mobile
Email
Ethnicity
Faith
Sexual Orientation
Preferred method of contact
Do you consider yourself to have a disability?
How would you like to be involved?
Service preferences
How are you connected with the Trust?
How did you hear about the trust?

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