If you would like to add your name to the Hand Back Our Hospital campaign, please use the form below:
| Hand back our hospital because... | |
| Your reason:: | |
| Full name: | |
| Address: | |
| Tel: | |
| E-mail: | |
| Occupation | |
| Age: | |
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Please Note: In sending this form you are giving your consent for your details to be published.
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