Fill out the online form to become a member


Go straight to the form on this page

 

Infomation about using this form


Why use this form?


To register your interest in becoming a member of Cambridge University Hospitals NHS Foundation Trust (for Addenbrooke's and Rosie Hospitals).

If you become a member, you will be eligible to stand for election as a governor of the NHS Foundation Trust.

Are you eligible?

Before you complete this form, please check that you are eligible for membership (ie a current or past patient or carer, staff, someone who lives in the membership area - Catchment area information.

Are you a member of staff?

Eligible staff do not need to complete this application form - you will be automatically members unless you choose to opt out (if you opt out while remaining an eligible member of staff, you can not join as a patient or public member). Details of eligibility.

Are you interested in standing for governorship?

For prospective governors - please read this information before making your decision to stand...Nolan Committee: The seven principles of public life

Do you want to opt out of being listed in the register of members (public and staff members)?

Public and staff members have the right to request that their details are not made available to the general public in the register of members.

To do so please call the NHS Foundation Trust Membership Office on 01223 256 256 or email

foundation.trust@addenbrookes.nhs.uk

Patient members’ details are already withheld from general public view

Why do you need all this information?

We need to have some details to be able to contact you. We have also asked for information that can help us to see if our membership will represent our users and staff - this information is optional but would be very helpful to us. Please complete all the 'essential' sections or the form will not be sent through to us - you will be asked to try again.

This information will be stored and used in accordance with the Data Protection Act.

What happens next?

If you are interested in becoming a member or governor, we will contact you by post with further information about the NHS Foundation Trust and/or election forms.

At this time, we will ask for your signature to help validate who you are. Establishment of an NHS Foundation Trust is subject to appropriate legislation.

 

Online Form

1. Type of interest:

Are you be interested in becoming a:

or (select one or both) - please read the information for governors (including the Nolan Committee: seven principles of public life) before selecting this option.

NB If you apply to be a member of the NHS Foundation Trust you will be bound by its rules, which are subject to legislation and the agreement of a written constitution. A draft of the constitution is available on request.

2. Your title (so we can contact you):

4.

5.

6.

7.

8. Telephone numbers (optional, so we can contact you):

No

9. Are you applying to be a (tick ONE ONLY):

If you live within the membership area and have also been a patient or carer, you will need to choose which constituency (group) you wish to belong to: 'patient' or 'public'. Eligible staff should not use this form - you will be contacted at work.

10. Please tick this box if you consent to your information being passed to Addenbrooke's Charitable Trust - a separate organisation to Cambridge University Hospitals NHS Foundation Trust - so that they can keep you informed of their activities.

11. (Optional) information that helps us see if we have reached a wide representation of our users and staff:

a. Your gender:

b. Your age:

* NB you must be aged at least 16 years to become a member or governor

c. Your date of birth:

background

White and black African

Any other black background

ethnic group

Not stated


 

Related pages

Related pages: Frequently Asked Questions: Becoming a member

Last updated: 20 April 2007
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