If you would like to join us as a member please fill in the form below and one of the team will get back to you. First name Surname Address Address Address 2 City/Town Postcode Telephone Email How would you like us to contact you? Email Post Telephone Gender Female Male Other Prefer not to say Date of birth Where did you hear about becoming a member? Ethnicity White British White Other Black Carribean Black African Somali Black Other Yemeni Indian Pakistani Bangladeshi Chinese Vietnamese Asian Other Prefer not to say Other Enter other… I would like to be a member in the following group Public - Sheffield (must live in Sheffield) Public - outside Sheffield (rest of England) Service user (must have used Trust services within the last five years) Carer (must have cared for someone using Trust services in the last five years) Young service user or carer (must have used Trust services or cared for someone using Trust services in the last five years and be aged under 35) If you are a service user or main carer which of our services do you use? Adult metal health (aged between 18 and 65) Older people's mental health (over the age of 65) Clove Group (GP practice) Learning disability service Substance misuse (alcohol, opiates or non-opiates) Specialist services Other Enter other… How much would you like to be involved? Receive members magazine Receive email updates Attend memeber's events Get involved in a working group Become a Governor I'm interested in becoming a Governor but would like to know more All of the above What areas are you particularly interested in? Developing services Carer's needs and support Appointing staff and training Faith and spirituality General practice Dementia care Service user information Quality and standards Community services Psychological services Substance misuse Women's mental health Inpatient care Employment services for service users Needs of minority communities Medicines All of the above Your personal details will be stored on our membership database in accordance with the Data Protection Act and will not be shared with any other organisation. Register of members Foundation Trusts are required to publish and make public a register of members. If you do not wish your name to appear on the public register please tick the box. rgb(255,255,255) Related content Membership
