Application to become a Member

By clicking on the "Send" button at the end of the page, this form will be sent to the Gloucestershire Hospitals NHS Foundation Trust.

 

Title
Gender*

Optional Section (by completing this section you help us to make sure our membership represents our community in Gloucestershire)
Level of Involvement - please indicate what you are interested in (you may click more than one)
Level of Involvement


Please select which group you belong to:
Select Group


We are really keen to listen to the experience of carers of patients
Are you a carer?

Please tell us how you found out about membership
Found Membership




If you were introduced by a Staff Member, please enter their details below:
The above information will be retained by the Trust and will only be used in connection with NHS Foundation Trust Status.
Names of Members will be included on a public register. The information will be stored and processed in accordance with the data protection act.
* Required fields