BSSH/LION Hand Unit Volunteer Predeparture Form

Contact details

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* 1. What is your name? (please enter your name and title as displayed on your passport)

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* 2. Date of birth?

For our group insurance policy, please tell us your date of birth

Date

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* 3. Please tell us your home address

Address

Address 2

Town/City

County

Post Code

Country

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* 4. Please tell us your work address

Hospital/unit etc

Address

Address 2

Town/City

County

Post Code

Country

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* 5. What is your email address?

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* 6. What is your mobile phone number

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* 7. Are you happy to be added to the volunteers WhatsApp group/s

Yes

No

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* 8. Do you give the BSSH permission to use any photographs of your image for the purposes of publicity and/or marketing material?

Yes

No

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* 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?

Yes

No