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Membership Application Form

Please complete the form below if you would like to be a public member of the Foundation Trust. Alternatively contact the Membership Office and a form will be sent to you.

What are the benefits of being a member?

Members will:

  • Receive news and information about the trust and its activities throughout the year.
  • Be invited to attend special events and lectures, and see ‘behind the scenes’ of our hospitals.
  • Be eligible to vote for, or stand for election to, the Council of Governors, and represent the views of members.
  • Be consulted on plans for the future development of the foundation trust and its services.

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 Data Protection Act. Full details available upon request.

Consent Agreement:
"I apply to become a member of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust. I consent to the processing of my personal information for the purposes of my membership by the Trust."

Contact Details

Name:

Postal Address:

Post Code:

Telephone:

E-mail Address:

About You

Gender:

Male   Female

Date of Birth*:
* to become a member you must be aged 16 or over

Ethnic Group:

White

British

Irish

Other White

Black or Black British

Black Caribbean

Black African

Other Black

Asian or Asian British

Asian/Indian

Asian/Pakistani

Asian/Bangladeshi

Other Asian

Other ethnic group

Chinese

Other ethnic group

Mixed

White & Black Caribbean

White & Black African

White & Asian

Other mixed background

 

Consent Agreement
"I apply to become a member of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust. I consent to the processing of my personal information for the purposes of my membership by the Trust."

 

Related pages
Video
The Benefits of Membership
Council of Governors
Boundaries for Public Membership
Membership Report
Membership Strategy
 
Local Involvement Networks
N Lincs LINk (Who Cares)
NE Lincs LINk
East Riding LINk
 
Other related sites
Department of Health Foundation information
Monitor

 

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