Associate membership application form

1. Your details

Thank you for applying to join Oxleas NHS Foundation Trust as an associate member.

We care for people across Greenwich, Bexley and Bromley as well as providing health services in prisons across Greenwich and Kent. We provide a wide range of community health, mental health and learning disability services. We work at around 100 health sites as well as in local schools, children's centres and, of course, in people's homes.

We also own Queen Mary's, Sidcup and provide some services there alongside a number of other NHS providers. For more information visit qmh.oxleas.nhs.uk

The information you provide will be shared with colleagues within the trust to help us build closer relationships between your services, our staff and our service users.

1. Please complete the following

Organisation / business name
Address
Postcode
Key contact (name)
Job Title
Phone number
Email address
Website
Location/borough

Comments:

2. Type of organisation

Comments:

3. Please give a brief description of your organisation's purpose and aim

Purpose
Aim

4. Are there any areas of Oxleas' work that are of particular interest to you?

Comments:

5. Can your organisation offer any of the following?

Work opportunities, paid, voluntary and apprenticeships to our service users who have experienced health problems; including mental health, learning disabilities and physical ill health, who we are actively supporting to get back into the working environment.
Help promote Oxleas by displaying posters and/or flyers about events, services, etc.
Take some membership application forms for staff and/or people who use my services. (Anyone aged 14 and over using, or caring for someone using, our services or has used them within the past five years can become a service user/carer member. Anyone aged 14 and over living in England can become a public member.)
Offer discounts. concessions or special offers to our staff and/or members?

Comments:

6. Would you like Oxleas to give you any of the following information? I would like

An Oxleas representative to contact me to discuss the services we provide.
More information about offering work opportunities, paid, voluntary and apprenticeships to Oxleas service users.
To find out more about the services Oxleas provides.
To discuss opportunities for partnership working.
To discuss how we can promote each other's work.

Comments:

7. If you are a voluntary, community or faith group, would you like Oxleas to promote your organisation on our website/intranet?

Yes please
No thanks

Comments:

Thank you for taking the time to complete this application form.