Please fill in your details below to become a member of Nottingham University Hospitals NHS 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
Councillor
Pilot Officer
Col
Maestro
Major
Commodore
Cllr
Sister
Master
Lady
Mayor
Lord
Sir
First name *
Last name *
Middle name
Date of birth *
DD
MM
YYYY
Gender
Unspecified
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
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
2. Additional Information
How would you like to be involved?
Would consider standing as a governor
Newsletter only
Newsletter and events
Newsletter, events, additional mailings/consultations
Wants to participate in public consultation
I Would Like to Register as a Member of East Midlands Ambulance Service (EMAS)
Your interests
Medical Matters
Patient information
Hospital environment
Auditing our services
Future service development
Patient food and menus
Faith needs
Minority community needs
Employment opportunities
Carers’ needs and support
The Nottingham University Hospital Charity
Our role as an organisation supporting local communities
Are you a member of any connected organisations?
Member of East Midlands Ambulance Service
Member of Sherwood Forest Hospitals NHS Foundation Trust
Member of Nottinghamshire Healthcare NHS Trust
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
Preferred method of contact
Disabilities
How would you like to be involved?
Your interests
Are you a member of any connected organisations?
4. Finish
*
I apply to be a member of Nottingham University Hospitals NHS 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.