North Staffordshire Combined Healthcare Listening and Engagement Active Partnerships (LEAP) Sign-on Form

Organisation Name*
LEAP Partnership Activities*
Please choose as many of the options below as you would like to engage in with us.
- Social media joint promotion, retweet, like, comment
- Sharing lists of upcoming events or campaigns ( where suitable)
- Identifying opportunities for our organisations' work to be featured and/or referenced in relevant activities or publications from each of us
- Research/ articles that can be shared with each other (where appropriate)
- Inform each other of Awards opportunities to which each organisation could submit entries
- Identify opportunities for co-produced or co-hosted events and/or activities
- Supplying to each other relevant promotional material/leaflets/posters for display and circulation amongst each other
- Other (please specify)
Other proposed activity
Please give details below of your other proposed LEAP activity

LEAP Organisation Lead Contact Name*
Lead Organisation Contact e-mail*
Lead Organisation Contact Telephone Number
Can we send you news updates from time to time?*
We would like from time to time to send you news updates about the work of Combined Healthcare? Are you content for us to do so?
- Yes, I am happy to receive news updates from Combined
- No, I would prefer only to be contacted in relation to my selected LEAP partnership activities
Agreement*
- The agreed organisation and North Staffordshire Combined Healthcare NHS Trust will continue to support one another through the agreed partnership tasks unless and until asked not to continue by the other Partner.
Our contact details
Email: communications@combined.nhs.uk, Telephone: 0300 123 1535 extension 2627, Website: www.combined.nhs.uk, Follow us on Twitter @CombinedNHS, Follow us on Facebook here

Listening and Engagement Active Partnerships (LEAP) Sign-on Form