Please fill in your details below to become a member of Cambridgeshire and Peterborough NHS Foundation Trust
Fields marked with * are mandatory.
Other fields are voluntary, but by giving us statistical information about yourself, you are helping us to measure and work towards building a Foundation Trust membership that is representative of the communities we serve.
1. Personal Information
Member type
Public
Service User/Carer/Family of Service User
Title
Mr
Mrs
Miss
Ms
Dr
Professor
Canon
Reverend
Wing Commander
Capt
Col
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Rt Hon
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
Male
Female
Please enter your postcode, and click Get Address
Home address *
Town or City
County
Postcode *
Country
Home telephone
Mobile
The Trust is committed to reducing its carbon footprint and future costs by using email communication wherever possible, so to ensure you receive all future member communications, please provide an email address.
Email
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
Prefer not to state
Atheism
Christianity
Buddhism
Islam
Jainism
Hinduism
Sikhism
Judaism
Other
Sexual Orientation
Prefer not to say
Heterosexual
Lesbian
Gay
Bisexual
2. Additional Information
Special Postal Requirements
Please do not send things in the post unless requested
Disabilities
No
Yes
A Learning Disability
A Sensory Disability
A Physical Disability
A Mental Health Problem
Any other special need (please list in box below)
What Level of engagement would you like?
All
Receive Members newsletters
Receive Invites to Members events and talks
Receive information on becoming a CPFT Volunteer
Consider standing for annual Council of Governors Elections
Participating in target surveys, consultations and provide feedback about our services
Receive information about our Head to Toe charity
*Please note that all members will be contacted to nominate and vote in annual Governor Elections and contacted regarding the annual members meeting.
To help us send you the right type of information please indicate the areas you are interested in
All areas of the Trust
Adult Mental Health
Adult Physical Health
Children's and Young people's services
Please tick here if you would like more information on becoming a CPFT Volunteer
Please tell us how you heard about our services
At an event
Recommended by a friend
Other
Friend or family member
Is there a particular members event that you are interested in attending?
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
Ethnicity
Faith
Sexual Orientation
Special Postal Requirements
Preferred method of contact
Disabilities
What Level of engagement would you like?
To help us send you the right type of information please indicate the areas you are interested in
Please tell us how you heard about our services
4. Finish
*
I agree to be a member of Cambridgeshire and Peterborough foundation trust and be bound by the rules of the organisation and give consent to the processing of my information.
Please note that all members will be contacted to nominate and vote in annual Governor Elections and contacted regarding annual members meetings as a condition of their membership.
This data will be used only to contact you in connection with your membership and to ensure our membership is representative of the population. All data will be stored in accordance with General Data Protection (GDPR). If you no longer wish to be a member at any time your data can be removed from our database by contacting us at foundationtrust@cpft.nhs.uk. Please click
here
for full details. Trust Privacy notice
here
.
Please tick here if you consent to your details being added to the Public Register.