Hospital Radio Bedside - Join - Hospital Visitor Application Form

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Hospital Visitor Application Form

» PERSONAL DETAILS

Full Name

Email Address

Daytime Phone Number

Evening Phone Number

Mobile Phone Number

Address

Minimum Age : 18

» IF YOU PREFER, YOU CAN DOWNLOAD A HARD COPY TO PRINT & POST

» HOW DID YOU LEARN ABOUT HOSPITAL RADIO BEDSIDE?

How did you learn about Hospital Radio Bedside?


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» DETAILS OF PREVIOUS EXPERIENCE

Previous charity / radio experience?


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» HOBBIES & INTERESTS

Please give details of your current interests or hobbies.


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» REFERENCES

Please give details of two people whom you have known for more than 2 years (not relatives)
Name Address Email Address	Name Address Email Address


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» AND FINALLY...

If you have a disability or health issue that might affect your activities with us, please give details.

Data Protection Act 1998. By submitting, I agree that my details may be kept on a computer file if membership is granted.


Back To Part 5	Online Application Form Complete

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