Patient Research Ambassador Expression of Interest form – If you are interested in being involved in raising the profile of research with patients and carers and would like to apply for a position as a patient research ambassador for the form and return it to: before 30/04/2017 Trust’s R&D department, please complete this Alternately you can post to: Jane Greenaway, Research & Development Manager, R&D Department, 1st Floor Middlefield Unit, University Hospital of North Tees, Hardwick, Stockton-On-Tees, TS19 8PE Title: Name: Address: Home: Telephone Work: number: Mobile: Email address: (if applicable) I would prefer to receive information by email post (please tick as appropriate)
Patient Research Ambassador – Expression of Interest form If you are interested in being involved in raising the profile of research with patients and carers and would like to apply for a position as a patient research ambassador for the Trust’s R&D department, please complete this form and return it to: before 30/04/2017 Alternately you can post to: Jane Greenaway, Research & Development Manager, R&D Department, 1st Floor Middlefield Unit, University Hospital of North Tees, Hardwick, Stockton-On-Tees, TS19 8PE Title: Name: Address: Telephone number: Home: Work: Mobile: Email address: (if applicable) I would prefer to receive information by email post (please tick as appropriate)
PRAI-Expression-of-Interest-Form.docx