• Membership Registration Form

    Your details

  • Date of birth
     / /
  • Tick all that are applicable

  • 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.

  • Monitoring Information

  • I have: (tick all that are applicable)
  • How would you rate your ME?
  • Today's date
     / /

  • By submitting this form you are giving your consent to R,K & WL 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 & WL ME Group to keep their personal data.

  • Questionnaire

    This questionnaire helps us to keep our group analysis up to date. All questions are optional. No names are attached to the analysis.

  • My GP is:
  • Are you currently seeing a consultant?
  • Compared to a year ago is your illness:
  • Do you receive care from Social Services?
  • Do you have a carer?
  • Should be Empty: