Registration Form

Please tell us your contact details and title of your idea. We will then send you a username and password that will allow you to submit a full application form.
Note: If you have multiple ideas, please register your details and the title of your first idea only. Once you have received your username and password you will then be able to add any additional ideas via the Inventors Login area on the application system Please provide as much information as possible. All fields marked with an * are mandatory fields.

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Name:	Title: -- Select title --DrMissMrMrsMsProfSir Firstname: * Surname: *
Occupation:
Are you employed/ paid by NHS:
Employing NHS trust:	-- Select a trust --City Hospitals Sunderland NHS Foundation TrustCounty Durham and Darlington Acute Hospitals NHS TrustCounty Durham PCTDarlington PCTGateshead Health NHS Foundation TrustGateshead PCTHartlepool PCTMiddlesbrough PCTNewcastle PCTNewcastle upon Tyne Hospitals NHS Foundation TrustNorth East Ambulance Service NHS TrustNorth Tees and Hartlepool NHS TrustNorth Tyneside PCTNorthumberland Care TrustNorthumberland, Tyne and Wear NHS TrustNorthumbria Healthcare NHS Foundation TrustNOT MEMBERRedcar and Cleveland PCTSouth Tees Hospitals NHS TrustSouth Tyneside NHS Foundation TrustSouth Tyneside PCTStockton-on-Tees Teaching PCTSunderland Teaching PCTTees, Esk and Wear Valleys NHS Trust*, Select NOT MEMBER if not applicable.
Department:	*
Address:	*
Postcode:	*
Work telephone:	*
Mobile:
Email:	*
Idea details
Title of idea:	*
Type:	ServiceDevice  *
How did you hear about us:	-- Select --email marketingI have dealt with NHS innovations North previouslyI heard a presentation by NHS Innovations Northinternet/websiteleafletNov 2007 Awards payslip flyerOtherPay slip flyervisited exhibition standWord of Mouth*
Heard about us other:	*
To continue with your registration, please read and accept our terms and conditions(*). Tick if you agree to our terms and conditions
Check code:	* For system security please enter the code KFsQEuKWCB into this box, it is case sensitive.