Edinburgh Carer Network
Membership Form
The Edinburgh Carer Network (ECN) is a pilot project which will be reviewed and
evaluated in July 2011 by the NHS Lothian Carer Support Team. Network members
will be informed about relevant Carer information and events primarily through
e-mail communications.
Your name in full:
Organisation name: (if applicable)
Job title: (if applicable)
Contact address:
Tel:
Fax:
Email: (please write clearly)
Postcode:
Web address: (please write clearly)
What level of participation would you like to have with the Edinburgh Carer network?
Receiving Information Only
Consultations
Attending Network Events and Meetings
Participation in working or advisory groups
Your sector: if applicable
Please tell us if you are a:
Voluntary/Charity
Carer Worker
Local Authority- CEC
Manager of a carer service
Local Authority- Other
(please specify below)
Health
Scottish Government
Private/Commercial
Please tell us if you are a:
Carer of a relative, friend or
neighbour
Former Carer
(please specify below)
Other Professional
(please specify below)
Other (please specify below)
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Areas of Interest: please tick all that apply
All Carer Groups
Black & Minority Ethnic Carers
Carers of people with Dementia
Carers of people with Mental Health difficulties
Carers of people with learning disabilities
Older Carers
Young Carers
Other, please specify:
Can you indicate which services your organisation or project offers to Carers please tick all that apply
Information packs
Formal support groups
Information leaflets
Informal/peer support groups
Regular Newsletters or bulletins
Counselling services
Training opportunities
Social opportunities
Short Break opportunities
Other, please specify giving a brief description
Sitter/Respite services
One to One support
Membership of Edinburgh Carer Network
Membership of the Edinburgh Carer Network will give you access to the following benefits:
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Opportunities to receive and contribute information updates about carer support relevant to the Edinburgh
area. It will allow you to share and circulate information about developments in your own organisation.
Invitations to attend Carer Network events and meetings.
The opportunity to inform strategic developments for carer service developments.
There is no charge for membership. All membership applications are approved by NHS Lothian’s Carer
Support Team.
Data Protection Act 1988 – Contact details are retained on our database for the purpose of giving information to
organisations or individuals in supporting the development of Carer services in Edinburgh. Occasionally we maybe
approached by third parties, for example, research organisations, for your contact details.
Please tick this box if you are happy for us to pass your details on.
For more information please contact Madeline Martin, Carer Coordinator on 0131-536-6215
Madeline.martin@nhslothian.scot.nhs.uk
Please return this form by email to Madeline.martin@nhslothian.scot.nhs.uk, or by post, to the
address below.
Madeline Martin, Carer Coordinator
North East Edinburgh Local Health Partnership HQ
Leith Community Treatment Centre
12 Junction Place
Edinburgh, EH6 5JA
T: 0131 536-6215
F: 0131 537- 6210
E: Madeline.martin@nhslothian.scot.nhs.uk
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