Full Name: Mr/Mrs/Miss/Ms/Other

Address:

Postcode

Telephone No: Mobile

E-mail address

Previous Hospital Radio (or other relevant) Experience (If Any)

Please circle which of the following duties would you like to help with. You may choose more than one.

Broadcasting Ward Visiting Fund Raising/Publicity

Production

Please state briefly why you would like to be a member of Radio Lonsdale:

Please note that all new members who wish to broadcast may be required to visit the wards to assist with the collection of requests, on completion of a CRB check which will be arranged by us.

Your application will be considered by the Committee and an interview will be arranged to complete the required forms for the Trust.

I wish to apply for membership of Radio Lonsdale.

Signature Date