Join us and help make our health services FIT FOR THE FUTURE
If you are interested in what we do and how we work then please support us by registering below and becoming a Member of our Trust. Members can help us improve our local health service and make sure our hospitals and community services are really meeting the needs of the people of Warwickshire.It's free to join and you can choose how much you want to be involved. You may simply choose to receive a regular newsletter, or you may want to take part in surveys or attend Members' events – the choice is yours. Just select the relevant options on the application form below.
Fields marked with * are mandatory.
1. Personal Information
Title
Unspecified
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Capt
Wing Commander
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Archdeacon
Commander
Dame
Justice
Lieutenant
Lieutenant Colonel
Sir
The Reverend Dr
Wing Commander
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Transgender
Please enter your postcode and click Get Address
Home address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
Email
Twitter
Preferred method of contact
Email
Post
Telephone
Ethnic Origin
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
2. Additional Information
How would you like to be involved?
Consider standing for election as a governor
Take part in consultation of the Trust's plans
Fundraising
Receive a regular newsletter
Take part in special projects, surveys or focus groups
Volunteering at the Trust
Find out more about the work of the trust
Interested in recruitment/apprenticeship opportunities
Attend career open days
Other Areas of Interest
Cancer Services
Cardiology
Care of the elderly
Career
Children's services (paediatrics)
Diabetes Care
Ear, Nose and Throat
Gastroenterology
Gynaecology
Maternity Services
Ophthalmology
Orthopaedics
Other support services (please list in ‘Notes’ section)
Physiotherapy
Radiology
Respiratory Medicine
Rheumatology
Specialist Services
Stroke
Urology
How are you connected with the Trust?
A carer of someone who is a patient
Volunteer
Have worked for Trust
A patient
Family or Friend of the Trust
Member of the Public
Interested in a Career with SWFT
How did you hear about becoming a Member?
Online Application
Other (please list in 'Notes')
From my GP's surgery
Media coverage
Member/Recruitment event
Outpatient Letter
Face to face recruitment
Through an employee of the Trust
3. Review
Last Used Services
Title
First name
Last name
Middle name
Date of birth
Gender
Address
County
Postcode
Country
UK
Home telephone
Mobile
Email
Twitter
Ethnic Origin
Preferred method of contact
Disabilities
How would you like to be involved?
Other Areas of Interest
How are you connected with the Trust?
How did you hear about becoming a Member?
4. Finish
*
By clicking submit I apply to join The South Warwickshire NHS Foundation Trust membership and agree to be bound by its
constitution
.
Thank you for taking the time to register. The data you supply will only be used to contact you about the Trust, membership or other related issues and will be stored in accordance with the current Data Protection Act. Your Data will only be given to a third party for the specific purposes of data cleansing, Governor elections and Trust mailings outsourced to an external mailing company. Please click
here
for details.
Please tick here if you do NOT want your name and constituency to be available to the public through the Foundation Trust Register of Members.