3 Albemarle Way
London  EC1V 4RQ
Tel: 020 7490 4227
Fax: 020 7490 1269
Email: mail@qni.org.uk

Registered charity: 213128

 

Registration Form

We would like to know how we can help you

Please complete this form to register your interest in the QNI, request specific information or publications, and let us know that you would like us to keep you informed in future.

Contact information
     Name:
  Job title:
  Email address:
 

Postal address:
    (This is my address)
  Daytime phone. no.
Professional information
  Are you:
 

A District Nurse


  A Practice Nurse
  A Nurse Partner
  A Queen's Nurse
  A Community Matron
  A Nurse Practitioner
  A Community Midwife
  A School Nurse
  A Prison Nurse
  A Health Visitor
  A Mental Health Nurse
 

Other community health practitioner
Please give details

 
 

Other
Please give details

  
I would like to join
  Community Nurse Forum

 Nurse Partners Network

 Professional Executive Committee Nurses Network

 Homeless Health Initiative Network

I would like to receive

Money Management CD

 QNI Newsletter (EMAIL)

 QNI Newsletter (POST)

 QNI Briefings
 

 
 



Data Protection

In accordance with the Data Protection Act 1998, the information you provide will be held in our database and used solely for the purpose of communicating with you, the registrant, and will not be shared with any third party.