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
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	Postcode House name/number
Address *
Town or City
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Postcode *
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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	Atheism Buddhism Christianity Hinduism Islam Jainism Judaism Sikhism I do not wish to disclose Not Stated Other (specify details in notes) Agnostic
Sexual Orientation	Heterosexual Gay Lesbian Bisexual I do not wish to disclose Not Stated

Disabilities	No Yes A sensory disability A physical disability A learning disability A mental health problem Any other special need (please list in the 'Notes' section)
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

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
Disabilities
How would you like to be involved?
Your interests
Are you a member of any connected organisations?

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