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I would like to * Join the MND Association
Renew my MND Association membership

If you are renewing your membership, please enter your memership ID.

Membership ID (as shown on your membership card)

Membership *

Standard membership

Person with MND - no fee
Carer of person with MND - no fee
Individual Membership - £12
Family Membership - £18
Reduced Rate - £6
Life Membership - £250

Associate membership

Organisational Membership - £25
Health & Social Care Professional - £12

Overseas membership

Include overseas membership ( additional £10 )

Your personal details Your Title

First Name *

Surname *

Billing Address (line 1) *

Billing Address (line 2)

Billing Address (line 3)

Billing Address (line 4)

Town *

County *

Postcode *

Country *

Day Phone

Email Address *

Date of birth

Carer information

What is your relationship to person with MND?

Carer
Spouse
Partner

Name of the person with MND

Membership information

Please complete this section if you are taking up Family Membership.

My family members are:

Name

Relationship

Date of birth

Associate membership information

Please complete this section if you are taking up the Associate Membership.

Some of our members have express a wish not to be mailed Thumb Print or not to be contacted by the local branch. Please tick if you would prefer:

Not to receive Thumb Print.
Not to be contacted by the local branch.

Make a donation I would also like to make a donation of
£

Increase the value of your gift by 28%

For every £10 you give we can get an extra £2.82, making your donation go even further. The Gift Aid scheme allows us to reclaim tax on every qualifying donation, whatever the amount. If you pay UK income tax and/or capital gains tax at least equal to the tax we will reclaim, please tick the box below.

I would like my gift to work even harder by ensuring the Government can add its contribution too. Please treat as Gift Aid donations, all donations I have made in the last six years, and all donations I make in the future, until I notify you otherwise.

Contacting you

From time to time we may write to you regarding developments about MND or to seek your support with financial appeals for our work. Please select one of the following boxes if you wish to receive:

All appeals Annual appeals only No appeals

Data protection

All personal details will remain confidential within the MND Association and will not be shared with any other organisations. You may inform us at any time if you do not wish to receive any further information from us. Please email membership@mndassociation.org

The MND Association complies with the Data Protection Act. Your details will be added to our database. You may inform us at any time if you do not wish to receive mailings from the MND Association.