Thank you for applying to join Sussex Community NHS Foundation Trust as a member.

Please complete all sections below.

Aged between 12 to 15? Please note you'll need to download and complete this printable form as it will need to be countersigned by your parent\guardian in order to become a member.


Fields marked with * are mandatory. 
Member type
Title
First name *
Last name *
Middle name
Date of birth *
Gender
  Please enter your postcode, and click Get Address
Address *
 
 
Town or City
County
Postcode *
Country
Home telephone
Mobile
Email
Preferred method of contact 




Ethnicity