STH FT Membership Form

Membership Form

To register as a Member of Sheffield Teaching Hospitals NHS Foundation Trust, please enter your details below:
Your name*

TitleFirst NameFamily Name
Your address*

Address line 1

Address line 2

Town/City

Postcode
Your phone no*
Your email address*

Confirmation EmailPlease confirm
Your date of birth*

DayMonthYear
Your gender*
Your ethnic origin - optional
This information is optional but allows us to ensure that our Membership reflects the diversity of our community.
What type of membership are you registering for?*

A public memberA patient member
How would you like to be involved?*

Consider standing for election as GovernorAttend Member eventsConsider volunteering at the Trust
Declaration*

I apply to be a member of Sheffield Teaching hospitals NHS Foundation Trust and be bound by the rules of the organisation. I give consent to the processing of my information.I consent to my details being added to the Public Register.
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.
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