Becoming a member

Submit request

To become a full member of the Association, please fill in your details below. Alternatively, you may send your details via email or download an application form and post to us.

Please correct highlighted items

Your Details

First Name
Surname
Address
Postcode
Country	United Kingdom Other...
Phone Number
Mobile Number
Email Address
Confirm Email Address

Child's Details

Do you have a heartchild

Yes No

Child's First Name
Child's Surname
Date of Birth
Heart Condition
Other Information

Contact Preferences

Newsletters	Yes No
Event info	Yes No
Preference	Email Email & Post
Preference	Email

If you express a willingness to be contacted as part of the self-help group we will try to put you in contact with other families with similar problems and concerns as your own.

Self-help group

Yes No

Confirm Entry

Above you should see an image containing six letters (A - Z). Please enter these six letters in the box below (why?).

Verification
	Only click once, submitting your membership request may take a short time.

If you have any problems with the above form, please submit your membership request by email instead.