Foundation Trust Membership Form

Please fill in the form to sign up as a member of the Foundation Trust. Remember, staff are signed up automatically. After you have sent the form someone will get in contact with you. If you have any questions about this form, please email ft@bdct.co.uk or telephone (01274) 363552. We currently have #5800 Members.

Bradford District Care Trust will not pass your details on to any third party, and all information will be stored in compliance with the data protection Act.

* Required fields

About You *

Title*
First name*
Last name*
Date of Birth* (Day) (Month) (Year)
Address *
Town
County *
Postcode*
E-mail*

Referrals

If a member of staff told you about this form please tell us who
Referral

Ethnicity *

Please select the box that best describes your ethnicity
White British
White Other
Black
Asian
Mixed Race
Chinese
Prefer not to say
Other (Please state below)

Group *

Please tick the group that best describes your relationship with the Trust. Members of staff are automatically signed up.
Service User
Carer
Member of the Public

As a Member would you like to:

Please select the box(es) that apply to you.
Receive regular information
Attend meetings and or events
Consider standing for election as a governor

Private Krankenversicherung