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HSC EMPLOYEES REGISTRATION FORM

HSC membership is only open to HSC staff. Membership is pending until eligibility checks are complete.

Surname:*
Forename(s):*
Title:*
Position Held:*
Job Category:*
HSC Trust:*
Expiry Date (if temporary contract):

Work Address:
Dept/Ward:*
Line 1:*
Line 2:
Line 3:
Line 4:
Postcode:
Work Email:*
Telephone:
Extension:

Home Address :
Line 1:*
Line 2:
Line 3:
Line 4:
Line 5:
Postcode:
Home Email:*
Telephone:*
Extension:

I have read and accept the terms and conditions of use.