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* First name:
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If applicable, please provide your role/affiliation:
* Where in the Yorkshire and Humber region are you based?
* How did you hear about the RDS YH Public Involvement Forum?
* Please provide a brief summary of any relevant experience, interests or training as a user representative in health and care services:
How would you like to be involved?
I would like to be an active member and attend regular meetingsI would like to be a involved in ad-hoc projectsI would like to receive all the minutes of meetings and information about the PPI ForumI want to be involved in email/postal consultations
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Age (if under 16 years)
Data Protection Act 2018 note: The information you give will be treated in confidence and disclosed only to those who need to know it in order to carry out the work of the Public Involvement Forum of the NIHR Research Design Service for Yorkshire and the Humber. By submitting this form or sending it to RDS YH staff, you are agreeing for us to store this information.