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Message

Wales Air Ambulance is committed to protecting your privacy and complying with the General Data Protection Regulation 2016 (‘GDPR’) and the Data Protection Act 2018 (‘DPA’). We will only use your personal data in accordance with data protection law applicable to England and Wales. For more information please visit our Privacy Policy at the foot of this page.

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Your name *

Organisation

Email *

Phone Number *

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First Name *

Last Name *

Phone Number *

Email *

To sign up please email fundraising@walesairambulance.com or use the enquiry form below. 50% of the fundraising target is to be raised by 31st Dec 2024 and 100% by 31st January 2025.

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Name *

Address *

Address 2 *

City/Town *

Postal Code *

Date *

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Name *

Email *

Contact number *

Address

Your Query *

Find out more about leaving a gift in your will *

I would like to be contacted by:

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First Name *

Last Name *

Email *

Phone *

Send your message to our Patient Liaison Nurses, they will be in touch with you shortly.

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Contact name *

Business name *

Email *

Telephone *

Please confirm where the box is located *

Do you require new seals for your box *

Business Opening Hours (opening time) *
:

Business Opening Hours (closing time) *
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Contact name *

Business name *

Email *

Telephone *

Please provide the location of where you plan for the box to go *

Business Opening Hours (opening time) *
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Business Opening Hours (closing time) *
:

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First name *

Last name*

Email *

Phone Number *

Brief details of your injury/experience *

Date of your injury/experience *

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Name *

Email Address *

Telephone Number *

Overview of the fundraiser, please provide as much detail as possible. *

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Title:
Mr.Ms.Mrs.Miss

First Name: *

Surname: *

Address: *

County: *

Postcode: *

Date of Birth: *

Contact Number: *

Email Address: *

Do you have access to a vehicle/transport? *

Do you have a valid driving license? *

What type of volunteering are you interested in doing? (Please tick all that apply) *

Please tell when you are available to volunteer: *

Please give us a brief description of why you would like to join Wales Air Ambulance as a volunteer: *

Please tell us about your skills and/or experiences that you feel would help you in a volunteering role: *

Are you a Welsh Speaker? *

Are you able to write in Welsh? *

Are you able to read in Welsh? *

Are you related to any volunteer, employee or Trustee of Wales Air Ambulance? *

If yes, please provide their name:

Do you have any criminal convictions? (This will not necessarily prevent you from volunteering with the charity) *

If you answered “Yes” please provide details:

Name: *

Job Title: *

Address: *

Referee’s email address: *

Referee’s telephone number: *

In what capacity does the referee know you? *

Name: *

Job Title: *

Address: *

Referee’s email address: *

Referee’s telephone number: *

In what capacity does the referee know you? *

I declare that the information provided in this application form is accurate and I am not aware of any circumstances which, if known or became known by Welsh Air Ambulance Charitable Trust might cause them to question my suitability for a volunteering role.

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