NIHR CLAHRC Wessex PPI Registration Form
The NIHR Collaboration for Applied Health Research and Care Wessex (CLAHRC Wessex - see our website: www.clahrc-wessex.nihr.ac.uk/) is committed to working with patients, their families, communities and members of the public to ensure that all its activities are meaningful and useful.

In order to help us to achieve this, we need to identify people who are willing to work with us through patient and public involvement (PPI). If you are interested in helping us, we would be very grateful if you could share some basic information about yourself by completing this form and returning it to Martin Simpson-Scott (contact details at bottom of this page). Please feel free to share with us as much information about yourself as you want.

The information below will be held by CLAHRC Wessex on a password-protected database. It will not be shared with any other parties unless you give us permission to do so. Upon registering, we will email you periodically with news about the CLAHRC, and about opportunities to work with our researchers. Please feel free to respond only to those opportunities which interest you, and for which you want to find time.

If you have any questions, or if you want to be removed from our database at any time, please contact Martin Simpson-Scott (PPI Coordinator) or email CLAHRC-WessexPPI@soton.ac.uk.

First name(s):
Your answer
Surname:
Your answer
Address Line 1:
Your answer
Address Line 2:
Your answer
Address Line 3:
Your answer
Address Line 4:
Your answer
Post Code:
Your answer
Best telephone number:
Your answer
Email address:
Your answer
I would rather NOT:
How would you prefer to be contacted?
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