Become a member

To be involved and influence decisions at your hospital please register to become a member using the form below.

As a member you will receive:

  • Invitations to hospital events including our open day and specialist evenings
  • The hospital newsletter, Connect, sent to you throughout the year
  • The opportunity to feed back your views and have a say in our future.

If you have any questions please call us on 023 8079 4853 or email UHSmember@uhs.nhs.uk|

If you have already registered as a member, you do not need to complete this form again.

By completing this form you are accepting the terms of our data protection statement |

[Fields marked * are mandatory]

Membership form

Title
  Other  
*  First name
*  Surname
*  Address
 
*  City or town
*  Postcode
Telephone (home)
Telephone (mobile)
*  Email
Do you have any special requirements?
Large Print
Audio
Do you have any other requirements?
Date of birth
Gender
Ethnic group
*  Please register me as a member
 

Data protection statement: The information you supply will be protected in accordance with current data protection legislation and will only be used in relation to the business of the Foundation Trust and its charity. We may combine your data with information from other parts of the organisation where it is relevant to do so. Your details will be treated confidentially and will not be disclosed to third parties without your prior consent - except to suppliers that process data on our behalf under equivalent conditions of confidentiality. You have the right to request that your information is not included in the public Register of Members. Details will be sent with confirmation of your membership.