Become a Member
Simply click here and fill in our online form to become a member and have your say.
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Become a Member
We want as many local people as possible to become members of 'Now Have your Say' - the public forum for NHS Stoke on Trent. In order to enable us to communicate with you effectively, and to ensure that we build a representative membership, we need you to tell us a bit about yourself. Please fill in the form below.
All of the information you provide will be kept strictly confidential in accordance with the Data Protection Act 1998 and we will only use this for matters relating to your membership.
Mandatory fields are marked with a * symbol.
SECTION 1
About You
About You
SECTION 2
Your Contact Details
Your Contact Details
SECTION 3
Other Personal Information
Other Personal Information
SECTION 4
Additional Information
Additional Information
