Name		
Address	
	
Post Code		
Telephone (1)		
Telephone (2)		
Email	
	
Date of Birth		
Place of Birth		

Please provide details of two persons we can approach to provide character references, these should not be members of your family.   If you have previously been involved with another Hospital Broadcasting organisation please make referee 2 an official of that organisation.

Referee 1	Referee 2	

 	

Please answer the following questions.

What is your current occupation ?	

Are you a member of any other voluntary organisation ?  If you are, please list them.	

	

Where did you first learn of Kettering Hospital Broadcasting Association ?	

	

Explain why you want to join Kettering Hospital Broadcasting Association (continue on a separate sheet if needed), what you expect to gain from joining the organisation and what you as an individual can offer.   Include any relevant skills and experience that will support your application.	

	

Please indicate how much time you are able to give to Kettering Hospital Radio (we look for a minimum of 2 hours every fortnight, rising to 2 hours per week once the probation period is ended)	

Conditions
1.	Acceptance as a member of Kettering Hospital Broadcasting Association is dependent on the outcome of an interview with the Committee.
2.	Terms and conditions of membership will be explained at the interview, and are listed in the Constitution and Rules, a copy of which will be made available to you.
3.	Continuing membership is dependent upon compliance with all rules and terms, and prompt payment of membership fees, currently £10 per year, payable 1st September each year.
4.	Kettering Hospital Broadcasting Association will not accept any liability for personal loss, injury or ailment as result of your patronage of The Association.

Returning this completed application is an indication of your acceptance of the above conditions.

Once you have completed this application either -
1.	Post it to : Membership Secretary, Kettering Hospital Broadcasting Association, The Studios, Kettering General Hospital, Rothwell Road, Kettering, Northants, NN16 8UZ
2.	Or email it to : khr-membership@hotmail.co.uk