NHS membership form

Please complete all parts of this form and read our terms and conditions and privacy statement before clicking on 'Submit' to register with us. The declaration at the end of the form explains why we gather this information, how we hold it and how we will use it, in accordance with permissions granted by you.

1. About you

Title (please select one) *

Name *

First

Last

Work telephone/mobile/bleep: *

Your contract: please tick: *

Permanent Fixed term staff On placement

If you are fixed term when does your contract end? *

If you are a student when does your placement end? *

Employer/Educational Establishment (i.e. your NHS Trust or university): *

Your job title: *

Name of your line manager: *

Site (where you are based e.g. Rotherham Hospital, Oak House): *

Department/Ward/Practice: *

University Registration Number (if student member): *

New staff: *

I'm still waiting to get my NHS email account (we'll add details to your library account once it is available):

If you wish to receive emails relating to overdue items at a different email address please specify an alternative below: *

2. Keep up to date: sign up for alerts

You've let us know above which email address we should use to contact you about overdue items. Please indicate below if you would like us to use this same email address to send you other alerts.

Please send me: *

Library news: send me updates about library services New books: send me an email alert when you add new books in my specialty or relevant to my department Alerts and bulletins: send me regular evidence updates on my professional interests. Please tick here then complete the section below to tell us more about your interests

Personalise your alerts & bulletins here:

3. How we use and store your data: please read, select and submit:

The information I have submitted is to the best of my knowledge accurate at the time of completion. I agree to inform the Library & Knowledge Service of any change of address or employment circumstances. I agree to abide by the conditions of use of the TRFT Library & Knowledge Service.

Your information is processed and held in accordance with data protection legislation. It will not be used for any purpose other than the administration of TRFT Library & Knowledge Service. Personal email addresses provided by you will only be used for the purposes outlined above.

The Library & Knowledge Service stores your information on an application called KnowledgeShare for internal library administration purposes. KnowledgeShare can also be used to share your contact details and professional interests with other NHS trusts that use it to promote knowledge sharing across the NHS: this will only be done with your permission. Please indicate your KnowledgeShare preferences below (you can change this at any time):

TRFT Library & Knowledge Service: Membership form for non NHS Staff

1. About you

2. Keep up to date: sign up for alerts

Personalise your alerts & bulletins here:

3. How we use and store your data: please read, select and submit:

TRFT Library & Knowledge Service:
Membership form for non NHS Staff