Progressive Neurological Conditions Community of Practice - registration

First Name

Last Name

Email address

Day Telephone number

Do you work for one of Hospice UK's member hospices?

Yes, I do

No, or I'm not sure

What is your role?

What seniority do you work at?

Name of hospice

To help us understand your connection to hospice care, please tell us which hospice you work with or alongside.

Please select the hospice from the dropdown list below.

Name of hospice

Job Title

Name of organisation you work for

By ticking the box below, you confirm that you:

- Would like to join the Progressive Neurological Conditions Community of Practice;

- Will actively contribute relevant knowledge and expertise;

- Will participate in online meetings and discussions

Hospice UK will only use the data you provide on this form, for the purpose of the Community of Practice. We will never sell or swap your data and we promise to keep it safe and secure in accordance with the Hospice UK privacy statement.

By ticking the box below, you confirm that you:

- Are expressing your interest in joining the Progressive Neurological Conditions Community of Practice;

- Understand that your application will be reviewed by the Community of Practice team;

- Will actively contribute relevant knowledge and expertise;

- Will participate in online meetings and discussions

Confirmation

I confirm I would like to join, and I agree to actively participate and contribute to the Community of Practice

Progressive Neurological Conditions Community of Practice - complete your registration

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