EoI South East Systems Leaders Peer Network and Learning Programme Expression of Interest South East Systems Leaders Peer Network and Learning Programme Terms and Conditions* Yes No (Form will not be accepted) By completing and submitting this form: I hereby give NHSE SE Talent and Leadership consent to keep a record of my name, job role, organisation, band (if applicable), telephone number and email address on their secure contacts database for management information and communication purposes. Please see our Privacy Notice. You can opt-out of these arrangements at any point by contacting us at england.setalentandleadership@nhs.net. Contact DetailsFirst Name*Surname*Role / Job Title*Organisation*Ashford & St Peters Hospitals NHS Foundation TrustBerkshire Healthcare NHS Foundation TrustBrighton and Hove City CouncilBrighton and Sussex University Hospitals NHS TrustBuckinghamshire Healthcare NHS Foundation TrustBuckinghamshire, Oxfordshire and Berkshire West ICBCentral Surrey HealthDartford and Gravesham NHS TrustEast Kent Hospitals University NHS Foundation TrustEast Sussex County CouncilEast Sussex Healthcare NHS TrustFirst Community Health and CareFrimley Park Health NHS Foundation TrustFrimley Health and Care ICBHampshire Hospitals NHS Foundation TrustHampshire and the Isle of Wight ICBIndependentIntegrated care 24Isle of Wight NHS Foundation TrustKent & Medway NHS & Social Care Partnership TrustKent Community Health NHS Foundation TrustKent County CouncilKent and Medway ICBMaidstone & Tunbridge Wells NHS TrustMedway Community Healthcare CICMedway CouncilMedway NHS Foundation TrustOxford Health NHS Foundation TrustOxford University Hospitals NHS TrustPortsmouth Hospital NHS TrustQueen Victoria Hospital NHS Foundation TrustRoyal Berkshire NHS Foundation TrustRoyal Surrey County Hospital NHS Foundation TrustSolent NHS TrustSouth Central Ambulance Service NHS Foundation TrustSouth East Coast Ambulance Service NHS Foundation TrustSouth, Central and West CSUSouthern Health NHS Foundation TrustSurrey & Borders Partnership NHS Foundation TrustSurrey and Sussex Healthcare NHS TrustSurrey County CouncilSussex Community NHS Foundation TrustSussex Partnership NHS Foundation TrustSurrey Heartlands Health and Care Partnership ICBSussex Health and Care Partnership ICBUniversity Hospital Southampton NHS Foundation TrustWest Sussex County CouncilWestern Sussex Hospitals NHS Foundation TrustOtherIf you selected ‘Other’ to the previous question, please specify.Please select the ICB your organisation is inBuckinghamshire, Oxfordshire and Berkshire West ICBFrimley Health and Care ICBHampshire and Isle of Wight ICBSurrey Heartlands Health and Care Partnership ICBSussex Health and Care Partnership ICBKent and Medway ICBI do not knowOtherIf you selected Other, please specify:E-mail Address*Contact Phone Number*Please share or provide information:Please provide a short summary of your current role and how you contribute to neighbourhood, place, or system-level working*Please share any specific topic areas or current challenges in your system, neighbourhood, or place that you feel would benefit from a collaborative approach during the programme*Are you interested in joining a long term Special interest network?YesNoPlease confirm that you confirm are available for the 4 sessions (Wednesdays 25th June and 16th July, Tuesdays 23rd September and 14th October)YesNoEmailThis field is for validation purposes and should be left unchanged.