Membership Signup

What is your full name? (required)

What is your postal address - First line, Town and County? (required)

What is your postcode (required)

What country do you live in? (required)

What is your email address? This will be the main way we contact you

What is your daytime telephone number?

What is your mailing preference? (required)

By email (worldwide including UK)By post (UK only)

If you are a UK taxpayer, our charity can claim Gift Aid on your donations & subscriptions. This is worth an additional 25% to the charity, at no cost to you. If you elect for Gift Aid you acknowledge that you are a UK taxpayer and understand that if you pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all your donations in that tax year, it is your responsibility to pay any difference.

Gift Aid (required)

Do you have genetic haemochromatosis? (required)

If you have been diagnosed with genetic haemochromatosis, what type is it?

If you have genetic haemochromatosis, what was the year of your diagnosis?

What is your gender? (required)

What year were you born in? (required)

How did you hear about us? (required)

I UNDERSTAND that all membership applications are subject to receipt of payment in-full via annual direct debit. Direct debits may take up to 14 days to clear. Membership packs are despatched upon receipt of payment. (required)

I UNDERSTAND

I CONSENT to Haemochromatosis UK processing my personal data in accordance with the terms of the charity’s Data Protection Policy & Privacy Notice (See https://www.haemochromatosis.org.uk/privacy-policy) (required)

I CONSENT

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