Library Registration Form Membership is available for: Bradford and Airedale NHS staff Health promoters in Bradford and Airedale Students who are on an NHS placement and/or studying in Bradford and Airedale Question Title * 1. Have you joined an NHS Library in Airedale or Bradford before? Yes No Question Title * 2. If you have selected 'yes' for question 1, please write the name you previously joined under Question Title * 3. Who is your employer? Bradford District Care NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Airedale NHS Foundation Trust Other (please enter your employer. If you are a student who is not on placement please enter your university) Question Title * 4. Title Dr Mr Mrs Miss Ms Question Title * 5. First Name Question Title * 6. Last Name Question Title * 7. Work or Placement Address(Please give your university details if you are a student who is not on placement) Job Title * Department * Site * Postcode Work email * Work Telephone Number * Question Title * 8. Home Address Address Line 1 * Address Line 2 (optional) Address Line 3 (optional) Town or City * Postcode * Home email * Home Telephone/Mobile * Question Title * 9. For students only: Name of University/College Question Title * 10. For students/temporary staff only: Last date of placement/employment at this Trust Date / Time Date Question Title * 11. Would you like targeted e-mail bulletins and updates on your professional interests? Yes No 33% of survey complete. Next
