CDHN Supporter Form

CDHN Supporter Form
This form is for people who want to join CDHN as a supporter. You can apply through your job or volunteer role or simply as someone who supports what we do. Supporters can live anywhere in the world, the only criteria is that you support CDHN Values, Mission and Vision.

You can read our Values, Mission and Vision here
Do you support CDHN Values, Vision and Mission?

Only people that support CDHN values, vision and mission can become CDHN supporters. You can read them here

What best describes the job/volunteer role in which you are completing this form? (if you have more than one role, please complete as the one most connected to CDHN work)

Other

About you

We’d like to learn a bit more about where you live, so we can tailor our communications to better suit your needs
Name

First NameLast Name
Email
Phone Number
Country you live in
Town/City you live in?
Which Trust area in Northern Ireland do you live?
Which Council area in Northern Ireland do you live?

About Your Organisation

In this section, we’d like to know more about the organisation you work or volunteer with. Our supporters come from a wide range of backgrounds—small community groups, large charities, health and social care (including GPs, pharmacists, and social workers), education, and government. Understanding this helps us show our reach and tailor our communications to your needs. If you’d prefer not to share this information, please go back and select “My application is not connected to a job/volunteer role.
No Organisation
Organisation Name
Role in Organisation
Organisation address

Street Address

Street Address Line 2

City/TownCounty

Postcode / Zip codeCountry
Organisation phone number
What Trust area in Northern Ireland is your organisation located? (if more than one area, please state where your head office is located)
What Council area in Northern Ireland is your organisation located? (if more than one area, please state where your head office is located)

CDHN will store your data securely and you have the right to remove your data at any time. You can view CDHN’s Privacy Policy here.
Do you agree to CDHN storing your data and receiving formal communication and updates via email, phone and SMS?
CDHN uses Mailchimp to send out our member Ezine. To do this, we need your consent to transfer your information to MailChimp. You can learn more about MailChimp's privacy practices here.
Do you consent to receiving our Ezine via Mailchimp?
To become a member, you must agree to CDHN’s Membership Terms and Conditions You can view them here
Do you agree to the Membership Terms and Conditions?
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About you