Kidney Unit Sustainability Champion - Sign Up Form
Thank you for joining our Kidney Centre  Sustainability Champion scheme. 

We are thrilled to welcome you to the scheme to support you and your teams to integrate sustainable practices across your kidney centre. We have a wealth of resources to support you and are on hand to guide you every step of the way. 

With very best wishes,
Lucy Brown
lucy.brown@sustainablehealthcare.org.uk

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Email *
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Please can you provide the name and contact email for the Lead of your Kidney Centre *
Full Name *
Email Address *
Job Title *
Please select which Main Kidney Centre you are associated with from the following list *
If you selected "Other", type the name and address of the Main Centre below
Select the Type of Kidney Centre you Represent *
If you selected Satellite Unit, please choose which unit from the below  *
If you selected "Other",  please specify below
If you selected "Other", type the name and address of the Satellite Unit below
If you selected your Satellite Unit from the list, can you confirm the name and address is correct? If not, please provide the correct details below. 
Would you be happy for us to share your name and the name of your healthcare organisation on the CSH Kidney Care Sustainability Network? *

Please confirm that you have registered on CSH Sustainable Healthcare Networks Hub https://networks.sustainablehealthcare.org.uk/ and have joined the Kidney Care network https://networks.sustainablehealthcare.org.uk/kidney-care-sustainability-network/about

*

Please confirm you give consent for the Centre of Sustainable Healthcare (CSH) and the UKKA Sustainability Committee to hold your details and to contact you with information about this sustainability work. Your contact details will be available on a database accessible to CSH, UKKA and the other Kidney Unit Sustainability Champions only, for networking purposes.

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A copy of your responses will be emailed to the address you provided.
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