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BSSH/LION Hand Unit Volunteer Predeparture Form
Contact details
*
1.
What is your name? (please enter your name and title as displayed on your passport)
(Required.)
*
2.
Date of birth?
(Required.)
For our group insurance policy, please tell us your date of birth
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
3.
Please tell us your home address
Address
Address 2
Town/City
County
Post Code
Country
4.
Please tell us your work address
Hospital/unit etc
Address
Address 2
Town/City
County
Post Code
Country
*
5.
What is your email address?
(Required.)
*
6.
What is your mobile phone number
(Required.)
*
7.
Are you happy to be added to the volunteers WhatsApp group/s
(Required.)
Yes
No
*
8.
Do you give the BSSH permission to use any photographs of your image for the purposes of publicity and/or marketing material?
(Required.)
Yes
No
*
9.
Are you happy for us to share your email address with other volunteers for the purpose of sharing information with those who will also be volunteering at the hand unit shortly before or after you?
(Required.)
Yes
No
