Membership Application

Thank you for your interest in the Patients Association and the work we do, we’re delighted that you want to join us and make a difference. It takes less than a minute to fill in our membership form and become one of our members.

Thank you again, your support is invaluable, and together we can work to improve life for patients.

Your details

Title

First name *

Surname *

Email address *

Confirm email address *

Address Line 1

Town/City

Postcode

How did you hear about us *

If ’other’, please specify

Your communication preferences

We will use your information in order to correspond with you about your membership subscription. As a member you are also entitled to receive our weekly and quarterly newsletters.

Please confirm that you would like to receive our quarterly members’ newsletter ’Patient Voice’ by ticking below:

Please send me Patient Voice via email

(If you prefer to receive a copy of Patient Voice in the post please let us know by calling 020 8423 9111.)

Please let us know whether you’d like to receive our weekly email newsletter by ticking the box below

I would like to receive the weekly newsletter

We would also like to keep in touch with you from time to time to let you know about the difference that your support is making, as well as giving you opportunities to get involved with patient surveys, fundraising, volunteering and our campaigns.

Please select your contact preferences below

I am happy to be contacted by emailI am happy to be contacted by postI am happy to be contacted by telephone

Our full privacy policy is available by clicking on ’privacy policy’ at the bottom of this page.

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