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     Ectodermal Dysplasia Society
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Join as a member

Members must be over 18. If your child has ED please join on their behalf. Membership is open to everyone.
If you have any queries regarding membership or the completion of this form please email: sue@ectodermaldysplasia.org

Full membership £10
Overseas membership £15
Associate membership £ Free

Before you complete this online form please enure that you have already set up a standing order or made a one off online payment to the value of the appropriate membership fee plus any donation. Payments to be made to
The Ectodermal Dysplasia Society at HSBC, Promenade Branch, Cheltenham, Glos. England.
Sort Code 40-17-10 Account Number 61730835
NB Please ensure that the reference quoted on the bank payment is your surname.

Member's Details (must be over 18)

Membership Type*

Full

Overseas

Associate


Payment Method*

One off full payment made

Standing Order has been set up


Payment includes a donation of £


gift aid logo   Make your membership subscription and any donations worth 25% more to the ED Society. Simply select the Yes option below. If you receive taxable income from U.K. wages, savings or pensions, we can reclaim the tax.
I would like the ED Society to treat all donations and membership subscriptions as Gift Aid donations
No Yes
NB If yes, you must pay an amount of income tax or capital gains tax at least equal to the tax we reclaim on your donations, currently 25p for every 1 you give.

Title*

 

First Name*

 

Surname*

   

Has ED?

No Yes - If yes, please select type from dropdown list below?


Occupation (you, or your partner if you do not work)

 

Hobbies

 

Address for correspondence

Address Line 1 *
   
Town*
   
County
   
Postcode*
   
Country*
   
Home Tel
   
Mobile
   
Email

NB Your Email address is your username when logging into the website. Please supply a password (up to 8 characters in lower case) for access to the Members Section of the website (please remember to keep a note of this)

I would like to receive my mailings by

 

Post E-mail

I am happy to talk with other members

 

Yes No

I am interested in helping the ED Society

 

Yes No


Other individuals with ED

First Name:

 

Surname:

Male? Female?

 

DOB

Type of ED


First Name:

 

Surname:

Male? Female?

 

DOB

Type of ED


First Name:

 

Surname:

Male? Female?

 

DOB

Type of ED


First Name:

 

Surname:

Male? Female?

 

DOB

Type of ED



Please use the box below if there are more than 4 people with ED and also for any other relevant Information

1998 Data Protection Act. Your details will be held by the ED Society electronically and will be used only in connection with your membership of the Society.

The ED Society will contact you when your account has been activated and you can access the Members Section.

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