Volunteer / Member Form Volunteer/Members Form TitleName First Last Address Street Address Address Line 2 City County Post Code Telephone NumberMobile NumberWhich area of Wolverhampton do you live in? Bilston East Bilston North Blakenhall Bushbury East Park Ettingshall Fallings Park Graiseley Heath Town Merry Hill Oxley Park Penn Springvale St Peters Tettenhall The Scotlands Wednesfield N Wednesfield S Whitmore Reans Other Date of BirthMarital StatusEthnic OriginGender assigned at birthSexual OrientationDisabilitySexPregnant? Yes No ReligionTick the boxes next to the opportunities you are interested in: Member (Keep up to date with HWW and join our mailing list) Community engagement representative (Help us engage with members of the community, promoting what we do and supporting us carrying out surveys and projects) Office Volunteers (Support us with office paperwork and online entry) Enter and View Authorised Representative (Support us on our Enter and View visits in Hospitals, GP s Surgeries and Care Homes. Subsequent to references and DBS Check) Work Experience (Are you a young person looking for work experience in these areas?) Consent I agree to my details stored securely by Healthwatch Wolverhampton.I give permission for the information supplied on this form to be stored and used in accordance with the General Data Protection Regulation 2018 (GDPR)
