Wycombe Hospitals Broadcasting Association
Registered Charity 254676
Serving Wycombe & Amersham General Hospitals
Studio Telephone Number: 01494 425500  email whba@whba.org.uk
(Form Downloaded From the Internet)

Application for Membership

(Please Complete this form in BLOCK CAPITALS)

Name:.......................................

Address:........................................................................

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Telephone No:.........................

Mobile................................

Email Address   .......................................................

Age (If under 18)       ...........	

Do you have any experience of broadcasting or a related activity?  YES / NO
If yes, please give brief details.

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All members are required to participate in fund-raising activities.  
Wycombe Radio broadcasts to Wycombe & Amersham hospitals, and has a studio at each hospital. Please indicate where and when you would prefer to undertake training/presenting.

Amersham	YES / NO 	High Wycombe	YES / NO	Both	YES / NO

Monday Evening	YES / NO	Tuesday Evening	  YES / NO	

Wednesday Evening	YES / NO	Thursday Evening	YES / NO

Friday Evening	 YES / NO	Saturday A M	YES / NO

Saturday P M	YES / NO	Sunday A M	    YES / NO

Sunday P M		YES / NO
Photograph. Should you be accepted for membership, you will need to obtain a passport-sized photo for an ID card.
Membership fees, All members are required to pay a membership fee.  Fees are pro rata, depending upon your joining date, the membership year is November to October.  You will be advised of the current rates of membership should your application be accepted.


Your name and address may be held on a computer for Association use only.  You visit the hospitals at your own risk.  The Health Authority and Wycombe Hospitals Broadcasting Association (WHBA) accept no liability for any loss of property or injury to any person or third party while on Hospital Radio Business.  Members agree not to make any claim on WHBA for any loss or injury however caused. ID badge must be worn/carried at all times whilst on WHBA business.  Payment of membership fees implies acceptance of the WHBA's  Constitution, Rules, Code of Practice and Standing Orders.
I accept and agree to comply with the above.


Signed...........................................

Print Name ......................................

Date................/........../..............

Please send this form to -	

The New Members Officer,  Wycombe Hospitals Broadcasting Association,
The Radio Room, Wycombe General Hospital, Queen Alexandra Road
High Wycombe, Bucks HP11 2TT	

Or email to  whba@whba.org.uk
if you email this form, you will need to sign an original before being accepted for membership)

PLEASE NOTE  - in order to reduce postage costs, if you have provided an email address we will use that address for correspondence.