Membership Application Form

We will use the details you give to provide you with information, to keep you in touch, and for election material. If you provide your email address and / or
your mobile telephone number, we may use these methods to contact you and save postage.

The information you give us will be held in accordance with The Data Protection Act 1998.

Disqualifications from membership

A person may not be a member of the Hertfordshire Partnership University NHS Foundation Trust:

  1. If, in the opinion of the Board of Governors, there are reasonable grounds to believe that they are likely to act in a way detrimental to the interests of the Trust.
  2. If they have, within the preceding two years been dismissed, other than by reason of redundancy, from any paid employment in any NHS body.
  3. If their name appears on the Sex Offenders Register.
  4. If, within the last five years, they have been involved in a serious incident of violence at any of the Trust’s inpatient, outpatient facilities/units or in the community against any of the Trust employees or registered volunteers.

 

* I have read the information above and confirm that none of the disqualifications from membership apply to me * required


Do you work for Hertfordshire Partnership NHS Foundation Trust * required




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Do you wish your name to appear on our public register? * required


Involvement and interests * required
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Gender:



Do you consider yourself, or have you ever considered yourself, to be transgendered?


Do you have a disability?











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Your reference number for this form is: HPFT-C 57839