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Register

All fields marked with an asterisk (*) are required.

Welcome to Join the Conversation!

In order to ensure that we involve you in engagement activities or events that are meaningful and relevant to you as an individual, the registration form asks a number of questions to establish your preferences. You can alter these preferences at any stage in the future by logging in to your account. You will only have to register once. Please note, by participating in any of the projects on this site, you are agreeing to share your views, comments and registration details in accordance with our privacy policy - both with the receiving organisation and with NHS South Central and West CSU who host the platform.

Screen name

Password

Passwords must be 8 to 16 characters and contain a combination of numbers and letters, with at least one lower case letter and one upper case letter.

Password confirmation

About You

Title

Maximum characters 255

First Name

Maximum characters 255

Surname

Maximum characters 255

Address

Maximum characters 255

Which county do you live in?

Postcode

Please could you state your gender?

Please let us know below:

Maximum characters 255

What is your year of birth?

(This will help us to ensure that any age specific engagement projects are appropriate for you)

Please could you state your ethnicity?

Do you consider yourself to have a disability?

The Disability Discrimination Act defines a disability as: "A physical or mental impairment which has a substantial and long term adverse affect on their ability to carry out normal day-to-day activities."

Taking Part

Please could you tell us about yourself?

Please choose the option that is most relevant to you

If you selected 'Other' please provide more details here:

Maximum characters 255

Please tell us how you would like to be involved?

Options are limited to

Select as many as you like

Terms and Conditions

I agree to the Terms of Use and Privacy Policy for using Engagement HQ