Online Membership Form Membership Form Title*First Name*Surname*Home address*Postcode*Home Phone numberMobile phone numberEmailGender*MaleFemaleYour date of birth* We will contact you by email, if you prefer to be contacted by post please indicate below. Post Please tick here if you do NOT wish your name to be included on the public register. Disability I consider myself to have a disability I do not consider myself to have a disability Meetings/EventsI am interested in attending meetings and eventsI am not interested in attending meetings and eventsStanding a GovernorI am interested in standing as a GovernorI am not interested in standing as a GovernorVolunteeringI am interested in becoming a volunteerI am not interested in becoming a volunteerWhiteCornishBritishIrishOtherMixedMixed-White and Black CaribbeanSecond Mixed-White and Black AfricanMixed-White and AsianOther mixed backgroundAsian or Asian BritishIndianPakistaniBangladeshiAsian BritishAsian CornishOther Asian BackgroundBlack or Black BritishCaribbeanAfricanBlack BritishBlack CornishOther Black backgrondOther ethnic groupChineseOtherData ProtectionThe information on this form will be kept by Cornwall Partnership NHS Foundation Trust and only used in connection with membership and public involvement. Except where you agree that your name may appear on the public register, the information will not be released without your written authority. This is in accordance with the General Data Protection Regulations (GDPR) and Data Protection Act 2018. EmailThis field is for validation purposes and should be left unchanged. Share this page Share via Email Share to Facebook Share to Twitter