Trusts United Membership Form Please fill in these few short questions if you wish to become a member of Trusts United Question Title Forename Question Title * 1. Forename Surname Question Title * 2. Surname Do you work for... Question Title * 3. Do you work for... South Tees NHS Foundation Trust North Tees & Hartlepool NHS Foundation Trust North East Ambulance Service - NHS Foundation Trust None of the above - independent member Please enter your email address Question Title * 4. Please enter your email address Are you happy for Trusts United to send you emails about news and events Question Title * 5. Are you happy for Trusts United to send you emails about news and events Yes No Question Title Done