Register for NHS membership

LIBRARY REGISTRATION FORM
You will receive a reply within 2 working days. If you don't receive an email within this time please contact the library.
library.blackburn@elht.nhs.uk

Fields marked * are required

* Indicates required field

Title *

Name *

First

Last

Date of birth *

Gender: *

Job Title *

Department *

Trust Email *

Personal Email *

Site or Base *

RBH BGH Community (please specify) Other (please specify)

If other *

Employing Organisation or University (if on placement) *

ELHT UCLAN Other (please specify)

If other *

Contract *

Permanent Temporary or Placement (please provide finish date)

If other *

Home Address *

Work Phone Number *

Mobile Number - by giving us your mobile number you consent to receive library notifications by text message *

Do you already have an OpenAthens account? *

Yes No Not sure

OpenAthens username if known *

How did you hear about us? *

Further Information
For further information on what information we store, how your information is used, who we share it with, and your rights to access it, please read our privacy policy

Your Declaration *

Yes

I agree for membership of the Library Service and agree to abide by the terms and conditions. I agree to my data being held as described above.

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