Membership form

Click on 'print' in the file menu on the toolbar of your browser, fill in the form, return it to: 

The Sussex MS Treatment Centre, Southwick Recreation Ground, Croft Avenue, Southwick, West Sussex, BN42 4AB, with a donation of £10 and you're a member for a year.

Membership Application

Please enrol me as a member of The Sussex Multiple Sclerosis Treatment Centre.

 
A donation of £
Making a total of £

 

Name

Address

Date of Birth

Telephone Number

e-mail address

Signed

Date

Office Use Only - All information is confidential.

Would you be willing to help the Centre?  We always need volunteers both at the centre and to help with fundraising events etc.

I can/cannot help
(please delete)

I can help at events/collections/at the centre
(please delete)

Type of help.......................................................................................

Would you like a vote at the AGM?  If you would you need to become a corporate member with a nominal shareholding in the company.  Please e-mail Alan for further details and a corporate member's liability form.