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Membership Application Form

Membership is free and open to anyone over the age of 12 and living in Bedfordshire, Central Bedfordshire, Luton, City of London, Newham, Hackney, Tower Hamlets or living in any other areas of England. Public Members will include service users, carers and local residents.

Your data is kept secure and will only be used to contact you about the Trust and will be stored in accordance with the Data Protection Act 1998.

Format: d.m.y
Address

Your ethnic background

White
Black or Black British
Asian or Asian British
Mixed
Other Ethnic Group

Your health service history

Have you ever used Mental Health Services?
If yes, please specify in what locality:
includes Central Bedforshire and Bedford Borough
Have you ever used Community Health Services?
If yes, please specify in what locality:
Are you a Carer for someone that has used Mental Health Services?
If yes, please specify in what locality:
Are you a Carer for someone that has used Community Health Services?
If yes, please specify in what locality:
Do you consider yourself to have a disability:

What services are you particularly interested in?

Tick as many services as required
East London NHS Foundation Trust relies on the many volunteers and service users who help us to keep improving the services we offer.

The Trust’s dedicated People’s Participation Service works to put service users, families and carers at the heart of everything we do. We continually seek new members to take on important roles across all areas of the Trust, in order to help keep improving the services we offer.

Please take a moment to consider whether you might be able to support the Trust in some way.
tick as many boxes as you wish
If you have ticked Volunteering, are you happy for your information to be handed over to the Trust’s People Participation team , and for someone to get in contact with you?
If you have ticked People Participation, are you happy for your information to be handed over to the Trust’s People Participation team , and for someone to get in contact with you?
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