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 only takes less a couple of minutes 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 (required)

First name (required)

Surname (required)

Email address (required)

Confirm email address (required)

Phone number

Address Line 1 (required)

Town/City (required)

Postcode (required)

How would you describe yourself? Please only select one

If you are a health professional are you a?

If you selected ’other’ please describe

How did you hear about us (required)

If ’other’, please specify

Your communication preferences

We would like to keep in touch with you from time to time to let you know about the difference that your support is making, and share opportunities to get involved in our work. Please let us know your preferences. (required)

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

Tell us which publications you’d like to receive from us.

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

Please let us know if you’d like to receive our membership magazine Patient Voice by ticking below:

Please send me Patient Voice via email

Patient Voice is published twice a year in the summer and winter.

What’s your main reason for joining the Patients Association?

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

Thank you for completing the membership form. When you click to send the form, you’ll see a welcome message and also a link to an anonymous questionnaire that asks a few questions about where you live, and other details. We’d be grateful if you’d complete it.