People's Question Time Hands Off HRI • Application Form

Apply to Join the People's Question Time Audience

Please enter your details into the form below to apply to participate in the People's Question Time as an Member of the Audience at the University Of Huddersfield on Tuesday, 26th April.

Your Contact Details (required)
Your Questions (required)
Demographic Details (required)

We need to ask the following demographic questions in order to ensure that the audience is as balanced as possible and reflects the entire community from the areas affected by the CCG's Reconfiguration Proposal.

N.B. All of the data that you supply below will be kept confidential by the Save Huddersfield A&E Campaign and will be deleted immediately after the People's Question Time event. At no time will your data be passed on to any other organisation. You have our 100% promise.

  • 16-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Male
  • Female
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • I'm an active member
  • I'm a member, but I don't take an active role
  • I'm not a member