Membership Application Form

Hospital Broadcasting for Northern Lincolnshire & East Riding of Yorkshire
Application Form
The Hospital Radio Studios Diana, Princess of Wales Hospital Scartho Road, Grimsby, North East Lincolnshire
Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth
Phone Number

Area CodePhone Number
Email
example@example.com
Do you have any experience using equipment such a broadcast mixer
Voluntary Work. Are you involved in any other voluntary work? If YES, please give details...
COMMITMENT
How long you can commit to Care Waves Radio?
WHEN AREN'T YOU FREE?
Please let us know when you are NOT available
ACTIVITIES
What are you interested in doing at Care Waves Radio (tick more than 1)
REFERENCES

Please supply two references (not family)
Reference 1:

First NameLast Name
Email
example@example.com
Reference 2:

First NameLast Name
Email
example@example.com
THE SMALL PRINT Please read, sign and date. Unsigned and undated forms will be REJECTED. By signing this application, you acknowledge and agree that if you are offered this volunteer placement, it will be strictly conditional upon successfully meeting all the Trust's recruitment requirements. Your minimum commitment will be one regular night a week. This placement permits access to the STUDIO ONLY when accompanied by a FULL MEMBER of Care Waves Radio. You are also RESTRICTED TO PUBLIC AREAS of the hospital ONLY. You agree to uphold the aims and objectives of Care Waves Radio and further commit to being bound by its Constitution and Rules of Procedure. Failure to meet the Trust's recruitment requirements, failure to comply with the rules of Care Waves Radio, or failure to adhere to the terms of this statement will result in the IMMEDIATE TERMINATION of your placement.
DATE

MonthDayYear
Date
Registered Charity No. 1104943. A voluntary service within the NHS Humber Health Partnership, funded entirely by donations. Formerly Grimsby Hospital Radio Est. 1951
Should be Empty:

Application Form

COMMITMENT

WHEN AREN'T YOU FREE?

ACTIVITIES

REFERENCES