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

Address:

PostCode

Telephone No: Mobile

email address

Previous Hospital Radio 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

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

Please note that all new members who wish to broadcast are required to visit the wards to assist with the collection of requests.

There is normally a waiting list for new presenters and preference will be given to those who have helped on the wards on a regular basis.

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