Membership Application For Cotswold Hospital Radio
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Name
 *
Address
 *
Email Address *
Telephone (Home)
 *
Type N/A if no home number
Telephone (Mobile)
 *
Type N/A if no mobile number
Date of Birth
 *

How did you hear about Cotswold Hospital Radio?

 *

Do you have any connection with any other or former members of Cotswold Hospital Radio?

 *

Why do you wish to join Cotswold Hospital Radio?

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Have you ever done any voluntary work before? (experience is not required, but if you have any particular experience to bring to us this is useful to know)

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Which Roles would you be suited to?
(Fundraising and Ward Visiting are Mandatory Roles (Terms & Conditions Apply)
 *
Required
Evening which you are available to volunteer between 6-9pm
 *
Required
I would be able to visit patients in *
Required
Declaration by all volunteers:  Have you ever been convicted of a criminal offence or been the subject to a Caution or a Bound Over Order?
 *
If yes please state the nature and date(s) of the offence:
You agree to abide by the Terms and Conditions of Membership *
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