Member application

Fields marked with * are required

Personal Details

By providing your mobile telephone number and email address, the Trust will be able to keep you up to date with news and information in a cost effective and environmentally friendly way.

Ethnicity Details

It is very important to Northumbria Healthcare NHS Trust that our membership is representative of the local communities it serves. So we can measure how successful we are in reaching as many people as possible, please complete the following section.

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Level of involvement

To ensure that you are happy with the amount of information you receive and that it is of interest, we are keen to know how involved you would like to be as a member and any areas of interest you may have. We have identified three levels of involvement for our members. On joining as a member, you will automatically be put into Level 1.

  • Level 1/Low involvement: This group of members will receive an electronic version of the Members newsletter and voting information only.
  • Level 2/Medium involvement: This group of members will also receive the newsletter and voting information, plus invitations to members’ events.
  • Level 3/High involvement: This group of members will, as above, receive the newsletter, voting information, invitations to events, and information about further involvement opportunities.

Data protection: Northumbria Healthcare NHS Trust will use the personal information you provide on this form to contact you via post, telephone, email and SMS about our Trust or other health issues. We will store and process your data in accordance with the principles of the Data Protection Act 1998. If you wish to opt out of being a Foundation Trust member you can do so at any time by contacting the Foundation membership office on 0191 203 1296 or email foundation@northumbria.nhs.uk