Donate Our Mission is to be OUTSTANDING for our patients, our communities and each other Membership Application If you would like to become a Member, please complete this form. Please consider if other Members of your family would like to join. You must be at least 12 years old before you apply for Membership. We're proud of our hospitals but know they can be even better with your help. We need as many people as possible to take the step of joining us a member of Warrington and Halton Hospitals NHS Foundation Trust - over 12,000 local people from across Warrin If you would like to become a Member, please complete this form. Please consider if other Members of your family would like to join. You must be at least 12 years old before you apply for Membership. Contact Details Surname Required Address Required Post Code Required How would you prefer to be sent information about the hospitals and membership? Post E-Mail Making the Most of your Membership Knowing how involved you want to be will help us develop the membership and ensure we send you the right amount of information. There are three levels of membership. All levels can vote in elections for hospital Governors and you can change your level of involvement at any time: Informed Member (You will be kept abreast of new developments and information regarding the hospitals through a quarterly newsletter and invites to Member only events and meetings. You will also be asked to participate in a number of activities such as detailed surveys; focus groups and special interest events.) Active Member (You might also be invited to join hospital groups, help us in service development meetings and increase your knowledge/skill in specific areas of interest.) Are you potentially interested in standing to be a hospital Governor in the Governor elections? Yes No I would like to volunteer for the Readers Panels About You The data you give will help us see if our Membership is representative of our local communities. Sex: Male Female What is your ethnic group? Please tick one of these boxes as appropriate. White: British Irish Other Mixed: White & Black Caribbean White & Black African White & Asian Other Black: Caribbean African Other Asian: Indian Pakistani Bangladeshi Other Other Ethnic group: Chinese Other I'd Rather Not Say Declaration Required I want to be a member of the Warrington and Halton Hospitals NHS Foundation Trust. I am not a Member of Staff. I am happy for you to use this information. NHS Foundation Trusts are required to publish a publicly available register of members. If you DO NOT want your name to appear on the public register please tick this box. Required I confirm I have read and consent to our privacy policy We're proud of our hospitals but know they can be even better with your help. We need as many people as possible to take the step of joining us a member of Warrington and Halton Hospitals NHS Foundation Trust - over 12,000 local people from across Warrington, Halton and the surrounding areas have already become members. In return you will receive regular information from us, a free newsletter, invites to events and the chance to participate in surveys and polls. You can also vote and stand as a public governor in future hospital elections. It’s free of charge and only takes a minute to join. Back to Membership and engagement Where to find us Warrington Hospital Lovely Lane Warrington WA5 1QG Tel - 01925 635911 Halton General Hospital Hospital Way Runcorn WA7 2DA Tel - 01928 714567 Become a member Our hospital magazine Research consent application form Hospital radio Warrington and Halton Teaching Hospitals NHS Foundation Trust CQC overall rating Good 24 July 2019 See the report Our Mission is to be OUTSTANDING for our patients, our communities and each other Show accessibility tools