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Family membership form

Please complete the form in as much detail as possible. There is no charge for membership however donations are welcome. You can join as a member if you are aged 16 and over.

About You (mandatory)

To enable us to keep in touch with you and to keep you up to date with any events that might be happening in our region please give your email address below.

About You/Your Child

Please give us as much information as you can. It will help us to develop the services for our members. Complete the following table with details of all family members affected by retinoblastoma:

How we keep in touch

Our newsletter is free to all members and is available in the following formats, please select the format you would like to receive:

How you can help us

The work of this charity could not be achieved without the vital support of its members. If you can spare us some of your time and would like to make a difference, why not consider becoming a volunteer for the charity? You could help us by raising awareness about retinoblastoma, getting involved with CHECT events or by providing administrative assistance.

Gift Aid it (optional)

Declaration (mandatory)