Join My Alder Hey!

1. I want to be a member of My Alder Hey
I am aged between 7 and 19 yrs
Yes
I need more information

2. I am a patient
Yes
I have been a patient of the hospital before
Yes
I am the brother or sister of a patient
Yes

3. What are the best ways for us to keep in touch with you?
Post Email Website
Other

4. I am aged between 16 and 19 and would like more information about becoming a Governor
Yes

5. Your details:

First Name:

Surname:

Age:

Birthday:

Address:

Town:

County:

Postcode:

Telephone:

Email:

The details you supply will be held on a confidential database. They will be stored and processed in accordance with the Data Protection Act 1998.