PDF Membership Application Form 2024

Membership Registration Form

Your details
Name
Address
Town
Postcode
E-mail
Phone number
Borough or county where you pay council tax or receive benefit
Date of birth

DayMonthYear
Date
Tick all that are applicable

I would like to receive the Newsletter by e-mailI would like to receive the Newsletter by postI would like to join the All Members WhatsApp GroupI would like to join the Younger Members' WhatsApp group ((open to those under 30 on joining)I would like to join the closed e-mail group

Annual Subscription / Donation

We suggest £5, we would welcome more if you can give it.
No subscription is required for members who are in financial hardship.
My membership subscription / donation for this year will be:
I will pay by:

Monitoring Information
I have: (tick all that are applicable)

ME/CFSFibromyalgiaLong CovidLyme
When did you fall ill with the illness above (approx)
Where did you hear about the Richmond and Kingston ME Group?
Today's date

DayMonthYear
By submitting this form you are giving your consent to R&K ME Group holding your personal data in our membership database in accordance with Data Protection Regulations. If you are completing this form on behalf of or as a representative of a young person aged 13 -18 you have also received their consent for R&K ME Group to keep their personal data.