Membership Application

Thank you for your interest in joining the Patients Association. Please complete the form as fully as you are able.

Membership of the Patients Association is now free, as we’d like everyone who wishes to join us to have the opportunity to do so.

The Patients Association is a registered charity and is reliant upon donations to help us to continue supporting patients and campaigning for change. When you submit the registration form you will be directed to an optional donation page. Please give what you can in support of our work.

Your details

Title

First name *

Surname *

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 let us know whether you’d like to receive these by ticking below:

I would like to receive the weekly e-news bulletinI would like to receive the quarterly Patients Association members’ newsletter by emailI would like to receive a paper copy of the quarterly Patients Association members’ newsletter by post

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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