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* 1. Contact Details

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* 2. Employer:

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* 3. Home Contact Details

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* 4. Your declaration:

We would like to contact you occasionally by e-mail. Please tick if you agree 

I agree that from time to time the library service may contact me using the personal data I have supplied, to ask for feedback about the services you provide and to make me aware of other services that you offer.

Please indicate



Before you submit your membership form, please make sure you have read the Privacy Notice and Membership Declaration and signed (below the section on KnowledgeShare).




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Would you like targeted updates on your professional interests?

  • You will automatically be joined to KnowledgeShare when you join the library.
  • Let us know your interests below to receive evidence updates straight to your inbox.
  • Help inform patient care, service improvement, research activity and clinical teaching.
  • Evidence updates are personalised and targeted according to the profile you create below.
  • Request evidence searches via the library website: www.surreyandsussexlibraryservices.nhs.uk
List your interests below to sign up to receive KnowledgeShare evidence updates by email:

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* 5. Condition / Risk Factors
e.g. diabetes, Gestational ....

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* 6. Professional Interests
e.g. patient safety, service design.....

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* 7. Age Groups
(please tick)

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* 8. Settings:
e.g. GP Surgery, Hospital Ward, Population Health.....

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* 9. Our systems help to share your information across the NHS by connecting staff with one another. If you agree please tick the appropriate boxes:

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* 10. We would also like to contact you occasionally by e-mail.
Please tick if you are happy for us to:

You may change these settings at any time at www.knowledgeshare.nhs.uk (Using your OpenAthens account).

Membership to KnowledgeShare is restricted to staff and students eligible for an NHS OpenAthens account
Privacy Notice and Membership Declaration

Using your personal information
We are committed to safeguarding your information. The information you supply will be used to contact you about services or resources you have requested from the Library and Knowledge Service (LKS).
 
From time to time using the personal data you have supplied we will contact you to ask for feedback about the services we provide and to inform you about our other services.

Sharing your personal information
We will share your information with the organisation that supply and manage our library management systems. We may share your information with other LKS teams if you move organisations (you will receive an e-mail notification if this happens).

Storing your personal information
The personal information you supply us will be added to our library management system (Workflows, Sirsi Dynix) and to KnowledgeShare (www.knowledgeshare.nhs.uk ).  These systems hold your data securely and library staff have to enter a password to access the systems
(see below for details of how you can access your personal information).

Accessing your personal information
You may log in to our library management systems at www.southeastlibrarysearch.nhs.uk (using your LKS PIN) or at www.knowledgeshare.nhs.uk (using your NHS OpenAthens account) to see the data we hold about you. You can request changes by emailing library.esh@nhs.net.

Deleting your personal information
We will delete the data we hold on you after a maximum 5-year period of inactivity (in case you return to use NHS Library and Knowledge Services again within this time).

Further information
For further information on how your information is used, how we maintain its security, and your rights to access it, read the full KnowledgeShare privacy policy online at www.knowledgeshare.nhs.uk

I apply for membership of the Library and Knowledge Service and agree to abide by the LKS terms and conditions. I agree to my data held as described above.

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* 11. By signing you also agree to the library rules and regulations, these can be found on the library front desk or via our library website: https://www.surreyandsussexlibraryservices.nhs.uk/about/joining-the-library/

FOR LIBRARY STAFF USE ONLY

Membership No:                                                   Pin:                                                                                                                                    
Base Library:        ES   /   ESC                                                                                                                       
Out of Hours Requested: Y / N    
Date given:                                                            Fob Number:
Membership Type Private Individual – Private corporate - Permanent -Temporary                            
Library Membership Expiry Date:                                                 
Input onto Library System Date:   
Welcome Email Sent?   Y / N

KnowledgeShare:                                                User Information                                 Professional Interests

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